tag:blogger.com,1999:blog-23170810299270932892024-03-12T21:15:07.118-07:00Empire of the MindA broad look at all things Psychology.Jay Joseph Duckworthhttp://www.blogger.com/profile/17356742306120820200noreply@blogger.comBlogger6125tag:blogger.com,1999:blog-2317081029927093289.post-38937515007326493572014-04-09T06:03:00.000-07:002014-04-09T11:38:45.150-07:00 What is Addiction?<span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;">A recent <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3939769/" target="_blank">paper</a> has been published in <i style="mso-bidi-font-style: normal;">Frontiers
of Psychiatry</i> which attempts to rebuke the supposedly dominant view of
addiction as a brain disease. I think it’s a decent paper - it gives a good account
of the problems with the “disease” view, and also covers evidence for both
sides of the debate – brain disease versus choice – in a balanced,
well-structured fashion. However, I think the authors’ conclusion and
suggestions for future perceptions of addiction are a little vague and, ultimately,
unhelpful, so I thought I’d try and clarify things a little further. I say this
not because I think that they’re wrong, but because they offer no structured
way of viewing addiction which others can draw from.</span><br />
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<b style="mso-bidi-font-weight: normal;"><u><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;">Background:</span></u></b><br />
<b style="mso-bidi-font-weight: normal;"><u><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;"><o:p></o:p></span></u></b> </div>
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</span><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;">Addiction appears to be a
nebulous concept in society, being used in everyday discourse to denote
something generally absorbing, or even just somewhat <a href="http://www.addictinggames.com/" target="_blank">appealing</a>. Even some
“experts” seem to have been drawn into the haze of confusion regarding the
reality of addiction, with <a href="https://www.youtube.com/watch?v=o3KsnoPom7s" target="_blank">this</a> psychiatrist comparing the “Trojan horse” of excessive<i style="mso-bidi-font-style: normal;"> </i>texting to drink and drug abuse
(warning, stupidity may be <a href="http://www.tandfonline.com/doi/abs/10.1080/15213269.2011.573461#.U0U9A_nIZTk" target="_blank">contagious</a>)*. Such confusion is one of the reasons
I’m writing this post – another is that, even when confident of what something
is <i style="mso-bidi-font-style: normal;">not</i>, it is still pertinent to
clarify what it <i style="mso-bidi-font-style: normal;">is</i>. Hopefully, this
is what this post will achieve. So without further ado, if addiction <i style="mso-bidi-font-style: normal;">isn’t</i> the propensity to eat more than
one (or eight) Ferrero Roche in one sitting, or the continuation of watching the
always looming next episode of your favourite show on Netflix (until you
suddenly realise it’s time for work), what exactly is it? The point of this
piece is to lay out a robust way in which addiction can be viewed in everyday
terms.</span></span></span><br />
<span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;"></span></span></span><br />
<span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;"></span></span><span style="font-family: Times New Roman;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;">Theoretically, contemporary models generally
pose addiction as a power struggle between a strong motivation to use the drug,
and a limited capacity to constrain such motivation. Practically, the <i style="mso-bidi-font-style: normal;">Diagnostic and Statistical Manual of Mental
Disorders - 5<sup>th</sup> Edition</i> (<a href="http://www.sciencedirect.com/science/article/pii/S0376871613001075" target="_blank">DSM-V</a>) has melded the previously
distinct categories of substance <i style="mso-bidi-font-style: normal;">abuse</i>
and substance <i style="mso-bidi-font-style: normal;">dependence</i> into a
unitary substance use disorder (SUD) with which to diagnose addiction-related
problems. Each substance-specific problem is granted its own SUD type (e.g.
alcohol use disorder, stimulant use disorder etc.), with each measured on a
continuum from mild to severe. In addition, the “behavioural addiction” of
pathological gambling has now been recognised as a disorder possessing similar <a href="http://link.springer.com/article/10.1007/s11920-010-0141-7" target="_blank">clinical manifestations</a> and even <a href="http://link.springer.com/article/10.1007/s11920-010-0141-7" target="_blank">neural correlates</a> to that of drug addiction.</span></span></span><br />
<span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: Times New Roman;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;"></span></span></span><br />
<span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: Times New Roman;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;">Essentially, addiction is a concept used to denote a set of states,
behaviours and consequences which centre around particular substances or actions,
and which are conducive to a problematic life. That’s it. Addiction can
principally be viewed as a set of behaviours that encumber much more negative
consequences than they do positive, but which the individual continues to
perform anyway (though as alluded to above, addiction also possesses biological
and cognitive components). That’s fine, but how about the all-important label?
Is it a biological disorder, or a disease, or a choice? And also, what about
sex, internet and “selfie” addictions – are these things real? We’ll start with
the latter.</span></span></span></span><br />
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<b style="mso-bidi-font-weight: normal;"><u><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;">Might
as well face it, we’re addicted to… everything:</span></u></b><br />
<b style="mso-bidi-font-weight: normal;"><u><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;"><o:p></o:p></span></u></b> </div>
</span><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: Times New Roman;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;">As we know, drugs are not the only things people have suggested can be
addictive. We’ve already seen how people somehow allowed on TV have termed the
very act of texting addictive; well, such claims stretch far and wide. <a href="http://en.wikipedia.org/wiki/Sexual_addiction" target="_blank">Sex</a>, <a href="http://en.wikipedia.org/wiki/Exercise_addiction" target="_blank">exercise</a>,
<a href="http://en.wikipedia.org/wiki/Internet_addiction_disorder" target="_blank">the internet</a> and <a href="http://en.wikipedia.org/wiki/Video_game_addiction" target="_blank">videogames</a> are just some of the behavioural normalities
accused of enticing some of us to the point of dependence. Could these things
ever be considered truly addictive? Well, why not? Many objections to such a
proposal seem to rest upon arguments from incredulity, that there’s no way a
videogame could ever be <i style="mso-bidi-font-style: normal;">that</i>
enjoyable or satisfying – but a lack of imagination as to how gratifying
someone <i style="mso-bidi-font-style: normal;">else</i> may find something is
not in itself an argument.<span style="mso-spacerun: yes;"> </span></span></span></span></span></span></span><br />
<span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: Times New Roman;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="mso-spacerun: yes;"></span></span></span></span></span></span></span><br />
<span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: Times New Roman;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="mso-spacerun: yes;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;">Take a recent example. The<i style="mso-bidi-font-style: normal;"> Mirror</i>
recently <a href="http://www.mirror.co.uk/news/real-life-stories/selfie-addict-took-two-hundred-3273819" target="_blank">reported</a> that a teenager had become addicted to taking <a href="http://en.wikipedia.org/wiki/Selfie" target="_blank">selfies</a> –
something which conjures up images of older readers shaking their heads and
muttering <i style="mso-bidi-font-style: normal;">“this country…”</i> But if
their report is accurate, this case was extreme and the person in question
undoubtedly needed help. This individual dropped out of school, didn’t leave
his house in six months and lost two stone due to his obsession of taking the
perfect picture. When he realised his goal was unattainable, he attempted
suicide. This spiralling out of control due to fixation on one particular thing
is reminiscent of addiction, and so it’s plausible to see why the connection
has been made. </span></span></span></span></span></span></span></span><br />
<span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: Times New Roman;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="mso-spacerun: yes;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"></span></span></span></span></span></span></span></span><br />
<span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: Times New Roman;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="mso-spacerun: yes;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;">However, despite such similarities some caveats need to be made. First,
it <i style="mso-bidi-font-style: normal;">might</i> be the case that “technology
addictions” actually exist and that such addicts can be categorised alongside
drug addicts (or perhaps more reasonably alongside the only recognised <i style="mso-bidi-font-style: normal;">behavioural</i> addiction, gambling), but we
need to be sure that these are in fact the same disorders. It is plausible, for
example, that this case in particular was just an unusual manifestation of obsessive
compulsive disorder (OCD) and body dysmorphia – two underlying conditions which
gave rise to behaviour eerily similar to addiction. If this is the case with the
other suggested “addictions” mentioned above – that sufferers are in fact just
showing an unusual presentation of symptoms of already established disorders –
then there is no reason for the creation of “new” addictions. To clear up such
confusion we only need ask a single, but broad, question: <i style="mso-bidi-font-style: normal;">are the profiles of such addictions similar to “classic” addiction? </i>We
can take “profiles” to mean clinical manifestations, environmental and biological
causes, underlying dysfunctions of the cognitive system and so on. If these
things are the same (or very similar) in these new age addictions, then there’s
no reason not to classify them as such. If they’re not then they must either be
classified as unusual manifestations of already-established disorders or something
completely new – either way, the important thing is to find the right diagnosis
for the right treatment.</span></span></span></span></span></span></span></span></span><br />
<span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: Times New Roman;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="mso-spacerun: yes;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"></span></span></span></span></span></span></span></span></span><br />
<span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: Times New Roman;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="mso-spacerun: yes;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;">The second caveat is that, even if we do eventually classify sex and
videogames as being potentially addictive, this does not mean that we have to
recognise them as having the <i style="mso-bidi-font-style: normal;">same</i>
level of addictiveness as drugs. It also, crucially, does not mean that we have
to grant that such addictions confer the same potential for harm (particularly
in health terms). Even between drug classes, we recognise that some are
potentially more addictive and harmful than others – the same could be done between
different classes of addictions. For example, gambling may confer similar negative
<i style="mso-bidi-font-style: normal;">social</i> consequences to addictive drugs
(loss of money, falling out with friends), but it does not possess the same
potential to deteriorate one’s health. Some addictions, it would seem, are
simply worse than others.</span></span></span></span></span></span></span></span></span></span><br />
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<b style="mso-bidi-font-weight: normal;"><u><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;">The <i style="mso-bidi-font-style: normal;">Choice versus Disease</i> debate:</span></u></b><br />
<b style="mso-bidi-font-weight: normal;"><u><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;"><o:p></o:p></span></u></b> </div>
<span style="font-family: Times New Roman;">
</span></span><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: Times New Roman;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="mso-spacerun: yes;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><i style="mso-bidi-font-style: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;">Scenario:</span></i><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;">
You’re at a dinner party and after the initial merriment which a few glasses of
wine delivers conversation turns thoughtful and, once the obligatory topics of
politics and religion have been navigated, talk turns to problems in society,
including addiction. Some suggest that addiction is an excuse, a way out for
the weak-willed and the morally bankrupt – after all, most of us enjoy a few
drinks on occasion, but we suck it up and turn in for work the next day. <i style="mso-bidi-font-style: normal;">We</i> take responsibility. Others rebuke
such claims with anecdotes of perfectly respectable family members or friends
who have succumbed to addiction – something which they describe as a disease. You
– who now can’t remember why you ever agreed to attend a party with such dull
people – are at a loss. On the one hand drug-taking is a choice, isn’t it? On
the other, why would people choose such a life – and aren’t there addicts who
want to recover, but can’t?</span></span></span></span></span></span></span></span></span></span></span><br />
<span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: Times New Roman;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="mso-spacerun: yes;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;"></span></span></span></span></span></span></span></span></span></span></span><br />
<span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: Times New Roman;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="mso-spacerun: yes;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;">These are reasonable questions, and even researchers in the field are
having similar discussions. Nora Volkow – head of the <i style="mso-bidi-font-style: normal;">National Institute on Drug Abuse</i> (NIDA) – is in the “addiction as
brain disease” camp, while Gene Heyman – a psychologist at Harvard University –
sees addiction as a problem of choice. So which is it? Well, a “disease” is <a href="http://www.oxforddictionaries.com/definition/english/disease" target="_blank">defined</a>
as a <i style="mso-bidi-font-style: normal;">“disorder in structure or function…
that produces specific symptoms or that affects a specific location”</i>. Now, <a href="http://dalailama.com/webcasts/post/300-mind-and-life-xxvii---craving-desire-and-addiction/4588" target="_blank">presentations</a>
of the evidence show that addiction can certainly fit the criteria of disease;
chronic use of drugs for example can significantly <a href="http://www.nature.com/neuro/journal/v8/n11/abs/nn1578.html" target="_blank">alter</a> the “reward pathways”
of the brain over time. However, as Heyman points out in his book “<i style="mso-bidi-font-style: normal;">Addiction: a disorder of choice”</i>, many
addicts can and do quit when the stakes are raised high enough – something not
possible for “real” diseases such as cancer and diabetes. </span></span></span></span></span></span></span></span></span></span></span></span><br />
<span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: Times New Roman;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="mso-spacerun: yes;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"></span></span></span></span></span></span></span></span></span></span></span></span><br />
<span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: Times New Roman;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="mso-spacerun: yes;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;">The problem with debates of this kind is that the opposing sides can force
each other into ever more extreme positions, leading to a false dichotomy – the
positions of which nobody wants to side with. It is true that drugs can change
the brain; it is also true that it is inevitably choice which initiates and
maintains recovery. If both are true, we have no need to distinguish between
disorder and choice – instead of <i style="mso-bidi-font-style: normal;">choice
versus disorder</i>, how about <i style="mso-bidi-font-style: normal;">disordered
choice</i>? This is not a new concept, Mark Lewis – a “former”** drug addict
and current psychologist and neuroscientist – espoused just such a view a
number of years ago in <a href="http://pps.sagepub.com/content/6/2/150.full" target="_blank">response</a> to Heyman’s book. Though not a simple disorder,
our conception of it <i style="mso-bidi-font-style: normal;">can</i> be simple.
We don’t need to quibble about choice versus, well, anything, because choice is
a <i style="mso-bidi-font-style: normal;">part</i> of addiction. As long as we
include all the components in our explanation, we’re doing okay.</span></span></span></span></span></span></span></span></span></span></span></span></span><br />
<span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: Times New Roman;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="mso-spacerun: yes;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"></span></span></span></span></span></span></span></span></span></span></span></span></span><br />
<span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: Times New Roman;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="mso-spacerun: yes;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"></span></span></span></span></span></span></span></span></span></span></span></span></span><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: Times New Roman;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="mso-spacerun: yes;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;">But what about the treatment
and care addicts get? If it’s a choice should we really be spending taxpayers’
money “helping” them? Well, it’s important to note that “choice” does not equal
“free”. Our choices are swayed <a href="http://onlinelibrary.wiley.com/doi/10.1111/acer.12375/abstract" target="_blank">All</a>. <a href="http://www.jpeds.com/article/S0022-3476%2813%2900134-0/abstract" target="_blank">The</a>. <a href="http://en.wikipedia.org/wiki/Anchoring" target="_blank">Time</a>. And though you may think yourself
immune, this is plausibly just the result of another cognitive <a href="http://en.wikipedia.org/wiki/Optimism_bias" target="_blank">bias</a> (which
ironically indicates just how influenced we are by things of which we’re not
aware). Though, clearly, some influences are more compelling than others. This
brings us back to spectral thinking – it is not a case of choice versus no
choice, but how compelling one choice is compared with another. In the case of
addiction, the “choice” to keep using is far more gripping than the “choice” to
turn your life around and abstain. Consider the scenario below:</span></span></span></span></span></span></span></span></span></span></span></span></span></span><br />
<span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: Times New Roman;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="mso-spacerun: yes;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;"></span></span></span></span></span></span></span></span></span></span></span></span></span></span><br />
<span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: Times New Roman;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="mso-spacerun: yes;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><em>Imagine a favourite
reward of yours, a reward which – though enjoyable – impacts negatively on some
aspect of your life. On occasion you feel the urge to obtain that reward, but
you keep these cravings at bay with minimal effort and only indulge every now
and then. You fill in the majority of your time doing other things you love –
maintaining other hobbies, obtaining other rewards. Now imagine that – relative
to everything else – the reward has become five times, ten times more valuable.
The urge to indulge has become far greater than it ever was before – your
thoughts continue to cascade onto the same track again and again, with the
reward always meeting you at the end of the line. Alongside the increase in
craving, in wanting, there’s a decline in liking. You no longer enjoy the
reward the way you used to – but you no longer enjoy anything the way you used
to. Work, hobbies, social occasions – none make you feel the way they should. But
the reward takes the edge off. Sure, it’s not as good as it used to be, but
it’s as good as it gets. So you have a choice, you can muster all the effort
and willpower you can, for as long as you can and reject the only thing that
now offers any relief from the constant psychological and physical craving – or
you can accept that not having that reward in your life is no longer an option.
You want it. You need it. Life without it is unbearable.</em></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span><br />
<span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: Times New Roman;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="mso-spacerun: yes;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><em></em></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span><br />
<span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: Times New Roman;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="mso-spacerun: yes;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;">Based on descriptions from addicts themselves, this would seem to be not
too far from what it’s like to be dependent on highly addictive drugs like
heroin. Notice that the more one uses the substance the worse one’s life
becomes, but that the major source of relief is also the substance itself. It’s
an ever-escalating drama, with the substance playing both villain and hero. Addiction
is neither a complete disease, nor a complete choice; rather, it contains
aspects of both.</span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span><br />
<span style="font-family: Times New Roman;"></span><br />
<span style="font-family: Times New Roman;"></span><br />
<span style="font-family: Times New Roman;"></span><br />
<span style="font-family: Times New Roman;"><div class="MsoNormal" style="margin: 0cm -30.65pt 10pt -1cm; text-align: center;">
<b style="mso-bidi-font-weight: normal;"><u><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;">Addiction’s
Grasp:</span></u></b></div>
</span><br />
<div style="text-align: left;">
<span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: Times New Roman;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="mso-spacerun: yes;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;">Much of Heyman’s and others’ arguments centre on the fact that, when
offered a great enough incentive, many addicts <i style="mso-bidi-font-style: normal;">do</i> turn their life around and give up drugs. For example, the paper
I mentioned at the very start of this post cites numerous examples where
addicts have gotten clean after threatened with unemployment, jail time or them
being declared unfit to raise their children. However, a crucial thing to
notice is that they <i style="mso-bidi-font-style: normal;">need</i> such
significant incentives in the first place – slowly killing themselves and
gradually worsening their quality of life isn’t reason enough. If that isn’t
disordered choice I don’t know what is. It’s also worth noting that not all
addicts can be dissuaded of their drug habit – NIDA estimates that around <a href="http://www.drugabuse.gov/publications/addiction-science/relapse/relapse-rates-drug-addiction-are-similar-to-those-other-well-characterized-chronic-ill" target="_blank">50%</a> of
those receiving treatment still relapse. Further, it seems some addicts never
fully recover and remain addicted for life regardless of their loss of earnings,
partners, friends and even loss of their own children. These would be regarded as
the most severe cases on our spectrum; those for which incentives – no matter
how great – will not work.</span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></div>
<div style="text-align: left;">
<span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: Times New Roman;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="mso-spacerun: yes;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span> </div>
<div style="text-align: left;">
<span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: Times New Roman;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="mso-spacerun: yes;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;">Such instances do not disrupt our view of addiction as a disorder in
need of treatment. Disordered thinking, which leads to disordered decision-making
and therefore distorted choice, needs to be rectified if people are to live
happy, productive lives free from drug abuse. This is better not only for
individuals themselves, but also for society at large. Furthermore, treatments
of various “levels” of the addiction landscape can be considered, something
Satel and Lilienfeld discuss in the paper which initiated this post. They argue
that one reason for discounting addiction as a brain disease is that it is not
the most useful way to view addiction, given that other factors (social,
economic, geographical etc.) play a more significant role. Leaving aside any
discussion of the fact that such factors exert their influence by affecting the
brain (something which the authors do address briefly but which I won’t bother
with here), this seems like a sensible argument. This also means that there
must be many “levels” at which to treat addiction: social, economic, cognitive
and others. </span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: Times New Roman;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="mso-spacerun: yes;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span> </div>
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<span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: Times New Roman;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="mso-spacerun: yes;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;">Such a “levelled” approach to treatment is likely to prove most
effective overall, compared with any approach which attempts to “cure”
addiction via some pharmaceutical wizardry alone. It may also be the case that
different treatment levels or types correspond optimally to certain parts of
the spectrum. For example, small incentives (e.g. monetary rewards) and cognitive
<a href="http://cpx.sagepub.com/content/1/2/192.abstract" target="_blank">training</a> may be helpful for persons located on a part of the spectrum labelled
hazardous; however, such approaches may be futile for those deemed to be at the
more extreme end, who more so resemble what we picture when we hear words like
“addict”. For these individuals large incentives (e.g. loss of job, family) or
pharmacotherapy may be needed while, further still, the group who seem immune
to any kind of treatment may need to be subjected to multiple approaches
simultaneously. Again this is not new, it’s just that this seems to me to be the
most reasonable way to structure our discussions of addiction – to view it as a
problematic extreme of normal human behaviour, rather than an abnormal category
reserved only for those suffering from either biological or moral disease.<span style="mso-spacerun: yes;"> </span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: Times New Roman;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="mso-spacerun: yes;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="mso-spacerun: yes;"></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span> </div>
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<span style="font-family: Calibri;">* If, like me, you too have a masochistic penchant for
viewing media sources presenting baffling levels of scientific ignorance, <i style="mso-bidi-font-style: normal;">The O’Reilly Factor</i> is your holy grail.
Enjoy.</span></div>
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<span style="font-family: Calibri;">** I’ve placed “former” in quotation marks here as it’s arguable that no
one ever fully recovers from addiction.<o:p></o:p></span></div>
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Jay Joseph Duckworthhttp://www.blogger.com/profile/17356742306120820200noreply@blogger.com1tag:blogger.com,1999:blog-2317081029927093289.post-14837557627070936932013-12-02T02:41:00.000-08:002014-04-09T06:04:29.152-07:00Culture eats strategy for breakfast, but maybe strategy will have more luck over dinner: A review of the North West Alcohol Conference 2013<br />
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<span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 150%;">We recently attended the
North West Alcohol Conference in Liverpool. I, along with <a href="http://tash13579.wordpress.com/2013/12/03/culture-eats-strategy-for-breakfast-but-maybe-strategy-will-have-more-luck-over-dinner-a-review-of-the-north-west-alcohol-conference-2013/" target="_blank">Natasha Clarke</a> and Inge
Kersbergen summarise the highlights. (A slightly different version of this blog can be found at the University of Liverpool's Addiction Group <a href="http://livuniaddictiongroup.blogspot.co.uk/2013/12/culture-eats-strategy-for-breakfast-but.html" target="_blank">Blog</a>.)</span></div>
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<i style="mso-bidi-font-style: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 150%;">Natasha
Clarke<span style="color: red;"><o:p></o:p></span></span></i></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 150%;">Professor David Walker,
Deputy Chief Medical Officer of the NHS, gave the first talk. This focussed on </span><a href="https://www.gov.uk/government/publications/alcohol-strategy"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 150%;"><span style="color: blue;">The
National Alcohol Strategy</span></span></a><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 150%;">; the proposal put forward by the government
to tackle our society’s harmful use of alcohol. The key issue raised was the </span><a href="https://www.gov.uk/government/news/alcohol-strategy-consultation-report-phe-response"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 150%;"><span style="color: blue;">disappointment
of Public Health England</span></span></a><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 150%;"> with the government’s reluctance to
introduce minimum unit pricing (MUP), despite initial plans to implement it. Evidence
from </span><a href="http://www.addictionjournal.org/press-releases/drop-in-alcohol-related-deaths-by-nearly-a-third-follows-minimum-alcohol-price-i"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 150%;"><span style="color: blue;">Canada</span></span></a><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 150%;"> and
the </span><a href="http://www.ncbi.nlm.nih.gov/pubmed/20338629"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 150%;"><span style="color: blue;">Sheffield
Alcohol Policy Model</span></span></a><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 150%;"> indicate the implementation of a 45p MUP may
decrease alcohol consumption and reduce hospital admissions, yet the strategy
states that more evidence is needed. The sudden backtrack is suggested to be
due to intense lobbying from the alcohol industry; for example, the Wine and
Spirit Trade Association (</span><a href="http://www.wsta.co.uk/Press/wsta-comment-uk-government-response-to-the-alcohol-strategy-consultation.html"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 150%;"><span style="color: blue;">WTSA</span></span></a><span class="MsoHyperlink"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 150%;"><u><span style="color: blue;">)</span></u></span></span><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 150%;"> launched a campaign against the
proposal and claim that MUP would unfairly penalise the majority of responsible
consumers. </span><a href="http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001431"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 150%;"><span style="color: blue;">Previous
research</span></span></a><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 150%;"> has shown that the industry can use evidence to support
policies that are in line with their commercial interests and </span><a href="http://www.bmj.com/content/346/bmj.f1889?tab=responses"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 150%;"><span style="color: blue;">WHO</span></span></a><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 150%;">
stress that industry should have no role in forming alcohol policy.<o:p></o:p></span></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 150%;">So
what is being done? The government has committed to a ban of “below cost
sales”, with cost being duty + VAT. This is equal to roughly 21p per unit for
beer and 28p per unit for spirits, prices significantly lower than the original
proposed MUP. </span><a href="http://www.shef.ac.uk/news/nr/below-cost-selling-ban-1.294086"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 150%;"><span style="color: blue;">It
is estimated</span></span></a><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 150%;"> that only 1.3% of all units of alcohol would
be affected by this and that a threshold of 45p would have a considerably
larger impact. The government also mentions a pledge through the </span><a href="https://responsibilitydeal.dh.gov.uk/category/alcohol-network/"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 150%;"><span style="color: blue;">responsibility
deal</span></span></a><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 150%;">
to take 1 billion units out of the market by 2015; the Health Committee doesn’t
think this will have any </span><a href="http://www.publications.parliament.uk/pa/cm201213/cmselect/cmhealth/132/132.pdf"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 150%;"><span style="color: blue;">significant
impact</span></span></a><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 150%;">. A further emphasis was placed on education campaigns,
despite </span><a href="http://www.who.int/choice/publications/p_2009_CE_Alcohol_Lancet.pdf"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 150%;"><span style="color: blue;">evidence</span></span></a><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 150%;">
showing their ineffectiveness in reducing alcohol-related harm. <o:p></o:p></span></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 150%;">What
was clear is that the government are not doing enough. Words and promises
(especially ones that are broken) will not produce changes in the nations’
health. An audience member asked David Walker… “Can you change culture?” The
answer was “Yes, we can”. Using smoking and driving behaviours as previous
examples he explained that these are health aspects to which our outlook as a
nation has changed. Smoking attitudes took decades to alter and faced similar
pressure from the industry. The verdict was that we must continue to fight for
better policy, but an equal match of input from public health and industry is
continuing to prove difficult.<o:p></o:p></span></div>
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<i style="mso-bidi-font-style: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 150%;">Inge
Kersbergen<o:p></o:p></span></i></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 150%;">Discussions
then continued in different breakout sessions. Colin Shevills and Ali Wheeler
made a compelling case for changing licensing regulations. Licensed premises
are popping up everywhere in the country. You can now buy alcohol in a large
variety of places: in cinemas, indoor playgrounds, and even hairdressers’. And
the more traditional licensed premises keep growing in number as well. All
whilst we know from research that the density of licensed premises is related
to more alcohol-related harm and crime. The licensing act is still operating
under the premise that licenses are granted where possible, even if licensing
committees and communities want to limit the amount of licensed premises in an
area.<span style="mso-spacerun: yes;"> </span>Licensing committees have very
limited power when it comes to restricting licenses in high density areas or
taking licenses away. However, they do possess two powerful tools to limit
alcohol availability: Early Morning Alcohol Restriction Orders (</span><a href="https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/98124/Early-morning-restriction.pdf"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 150%;"><span style="color: blue;">EMROs</span></span></a><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 150%;">) and
Late Night Levys (</span><a href="https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/98126/late-night-levy.pdf"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 150%;"><span style="color: blue;">LNLs</span></span></a><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 150%;">). <span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="line-height: 150%; margin: 0cm -16.5pt 10pt -14.2pt; text-indent: 1cm;">
<span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 150%;">An
EMRO restricts sales of alcohol in a specific area at a set time between
midnight and 6am. Premises that are in violation of this order will receive a
fine. The LNL is an additional fee for licensed premises if they want to sell
alcohol between midnight and 6am. At first glance these policies seem very
similar. The difference lies in how voluntarily businesses restrict their
selling times. At the start of November 2013 a LNL has been introduced in the
city of Newcastle.<span style="mso-spacerun: yes;"> </span>So far, it seems like
this levy has the effect of an EMRO, as many businesses voluntarily decided not
to pay the additional fee, but to stop selling alcohol at midnight instead. The
proposed EMRO in Blackpool, on the other hand, was met with a lot of resistance
from the business owners. The speakers argue that it is therefore important
that businesses do not feel forced into restricting their selling hours to get
their full cooperation. Local licensing committees should make more use of the
tools they have, get more freedom to limit licensed premises in their area and
be able to involve the local community in their decision making. <o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="line-height: 150%; margin: 0cm -16.5pt 10pt -14.2pt;">
<i style="mso-bidi-font-style: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 150%;">Jay
Duckworth<o:p></o:p></span></i></div>
<br />
<div class="MsoNormal" style="line-height: 150%; margin: 0cm -16.5pt 10pt -14.2pt; text-indent: 1cm;">
<span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 150%;">Further
suggestions for policy change came from Mark Gilman, Strategic Recovery Lead at
</span><a href="https://www.gov.uk/government/organisations/public-health-england"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 150%;"><span style="color: blue;">Public
Health England</span></span></a><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 150%;"> and the </span><a href="http://www.nta.nhs.uk/"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 150%;"><span style="color: blue;">National Treatment Agency for Substance
Misuse</span></span></a><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 150%;">. Gilman, a man who speaks with an almost paradoxical
sense of passion and levity, offered advice which </span><a href="http://www.theguardian.com/society/2013/jun/11/mark-gilman-12-step-best-addicts"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 150%;"><span style="color: blue;">he
concedes</span></span></a><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 150%;"> many see as “<i style="mso-bidi-font-style: normal;">unscientific,
folky [and] quirky</i>”. His idea is that we need to place more emphasis on 12-step
programs in which addicts are forced to confront matters of “spirituality”.
Initiatives such as </span><a href="http://www.alcoholics-anonymous.org.uk/About-AA/The-12-Steps-of-AA"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 150%;"><span style="color: blue;">Alcoholics
Anonymous</span></span></a><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 150%;"> (AA) are of this breed, asking addicts to admit they are
“<i style="mso-bidi-font-style: normal;">powerless over alcohol</i>” and to
recognise that a “<i style="mso-bidi-font-style: normal;">Power greater than they
can restore their sanity</i>”. As Gilman admits, this may be a difficult pill
to swallow for many. First, non-spiritual individuals will find it </span><a href="http://www.ncbi.nlm.nih.gov/pubmed/12380849"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 150%;"><span style="color: blue;">problematic</span></span></a><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 150%;"> to
attain the “<i style="mso-bidi-font-style: normal;">spiritual awakening</i>” necessary
for success in many 12-step approaches. Additionally, though AA is effective at
reducing rates of drinking there are many </span><a href="http://www.ncbi.nlm.nih.gov/pubmed/16856072"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 150%;"><span style="color: blue;">equally effective treatments</span></span></a><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 150%;">
available which come without the mystical baggage.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="line-height: 150%; margin: 0cm -16.5pt 10pt -14.2pt; text-indent: 1cm;">
<span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 150%;">That
being said, there is an essential feature of 12-step programs which Gilman is
right to say should be an active focus of substance dependence treatments across
the country: social networks. Social support provided in 12-step programs appears
to be one of the primary mechanisms of action, accounting for as much as </span><a href="http://www.ncbi.nlm.nih.gov/pubmed/18425655"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 150%;"><span style="color: blue;">1</span></span></a><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 150%;">/</span><a href="http://www.ncbi.nlm.nih.gov/pubmed/12133128"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 150%;"><span style="color: blue;">3</span></span></a><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 150%;"> of
treatment effects in reducing harmful use. In fact, </span><a href="http://www.ncbi.nlm.nih.gov/pubmed/17663609"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 150%;"><span style="color: blue;">one study’s authors</span></span></a><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 150%;">
even remarked that “</span><i style="mso-bidi-font-style: normal;"><span lang="EN" style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 150%; mso-ansi-language: EN;">The addition of just one abstinent person to a social
network increased the probability of abstinence for the next year by 27%”</span></i><span lang="EN" style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 150%; mso-ansi-language: EN;">. Clearly, emphasis on social change is vital.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="line-height: 150%; margin: 0cm -16.5pt 10pt -14.2pt; text-indent: 1cm;">
<span lang="EN" style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 150%; mso-ansi-language: EN;">The subsequent speaker was Wim van den Brink, Professor
of Psychiatry and Addiction at the </span><a href="http://www.amc.nl/web/Research/Who-is-Who-in-Research/Who-is-Who-in-Research.htm?p=384"><span lang="EN" style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 150%; mso-ansi-language: EN;"><span style="color: blue;">Academic Medical Centre of the University of Amsterdam</span></span></a><span lang="EN" style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 150%; mso-ansi-language: EN;">. Taking advantage of the passionate but light-hearted
tone set by Gilman, van den Brink lamented a presentimental partial rebuke to his
predecessor, “<i style="mso-bidi-font-style: normal;">I agreed with almost
everything you said, but I’m going to disagree on some points just to make it
interesting…</i>” And so he did. He focused on his own recently published </span><a href="http://www.ncbi.nlm.nih.gov/pubmed/23873853"><span lang="EN" style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 150%; mso-ansi-language: EN;"><span style="color: blue;">research</span></span></a><span lang="EN" style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 150%; mso-ansi-language: EN;"> which
tested the efficacy of the drug Nalmefene on an alcohol-dependent population
(though patients were simultaneously given a </span><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 150%;">motivational and
adherence-enhancing intervention)</span><span lang="EN" style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 150%; mso-ansi-language: EN;">. <o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="line-height: 150%; margin: 0cm -16.5pt 10pt -14.2pt; text-indent: 1cm;">
<span lang="EN" style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 150%; mso-ansi-language: EN;">Two clinical trials had shown that Nalmefene reduced
drinking significantly in patients relative to placebo. However, what’s really
interesting about these results is van den Brink’s <i style="mso-bidi-font-style: normal;">post hoc</i> analyses of the data. These analyses were directly
relevant to the previous presentation as they show us what can be done for
patients who may not respond so </span><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 150%;">favourably</span><span lang="EN" style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 150%; mso-ansi-language: EN;"> to social intervention. The analyses compared the
effects of the drug on those whose drinking improved between screening and
randomization and those whose did not. This latter subpopulation of the
original studies – labeled “non-reducers” – was categorized as excessive
drinkers who remained as such despite minimal interventions; contrarily, the
former – labeled “</span><a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1530-0277.2011.01649.x/abstract"><span lang="EN" style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 150%; mso-ansi-language: EN;"><span style="color: blue;">reducers</span></span></a><span lang="EN" style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 150%; mso-ansi-language: EN;">” – were
those patients whose drinking reduced simply after the assessment of their
problem by clinicians. To put it simply, Nalmefene works, but it works so much
better in patients whose drinking patterns are not reduced by initial clinical assessment.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="line-height: 150%; margin: 0cm -16.5pt 10pt -14.2pt; text-indent: 1cm;">
<span lang="EN" style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 150%; mso-ansi-language: EN;">At this point, van den Brink highlighted the main flaw in
viewing social networking and cultural change as a panacea (not that this was
necessarily the viewpoint of any of the aforementioned speakers) – substance
dependence is not merely cultural, it’s biological too. “<i style="mso-bidi-font-style: normal;">For those patients who don’t respond to programs like AA, what shall we
say to them… shall we tell them to f**k off?!</i>” I believe was his gentle phrasing.
The important take-home message it seems is that for improvements to be seen
with regards to substance dependence, governments need to pay attention to the
evidence, and advances in policy and research – both cultural and psychopharmacological
– need to be made. </span><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div>
Jay Joseph Duckworthhttp://www.blogger.com/profile/17356742306120820200noreply@blogger.com0tag:blogger.com,1999:blog-2317081029927093289.post-64996714489414221342013-10-15T03:31:00.000-07:002014-04-09T06:04:22.609-07:00Latest blog from the Addiction Research Group: Is the adolescent brain wired for addiction?Professor Matt Field asks if teenagers are inherently more vulnerable to addiction:<br />
<br />
<a href="http://livuniaddictiongroup.blogspot.co.uk/2013/10/is-adolescent-brain-wired-for-addiction.html" target="_blank">http://livuniaddictiongroup.blogspot.co.uk/2013/10/is-adolescent-brain-wired-for-addiction.html</a>Jay Joseph Duckworthhttp://www.blogger.com/profile/17356742306120820200noreply@blogger.com0tag:blogger.com,1999:blog-2317081029927093289.post-45208238643062719462013-10-15T03:26:00.002-07:002013-10-15T03:26:50.202-07:00PhD: Study 1Jay Joseph Duckworthhttp://www.blogger.com/profile/17356742306120820200noreply@blogger.com0tag:blogger.com,1999:blog-2317081029927093289.post-88109644394398570022013-10-14T16:04:00.000-07:002014-04-09T06:04:37.288-07:00Meth: I choose you! Does study show addicts' choices are ultimately rational?Last month (16/09/13) <em>The New York Times</em> published an article in their science section entitled <em>The Rational Choices of Crack Addicts</em>, which was promoted online by numerous sources and proved to be quite popular. Incidentally, this popularity is evidenced by the numerous iterations of the original piece in various media outlets (some of which can be seen <a href="http://www.theatlantic.com/health/archive/2013/09/the-science-of-choice-in-addiction/280080/" target="_blank">here</a>, <a href="http://www.nytimes.com/2013/09/17/science/the-rational-choices-of-crack-addicts.html?adxnnl=1&adxnnlx=1382085192-8I3wGcDNnZvzrWBCaWH5+w" target="_blank">here</a>, <a href="http://www.huffingtonpost.com/2013/09/20/drug-addicts-make-rational-choices_n_3955171.html" target="_blank">here</a>, <a href="http://www.conservativehome.com/the-deep-end/2013/10/drug-addiction-is-a-choice-not-a-compulsion.html" target="_blank">here</a>, <a href="http://addictionmyth.com/a-conversation-with-columbia-neuroscientist-dr-carl-hart/" target="_blank">here</a>, <a href="http://www.forbes.com/sites/patrickmichaels/2013/09/20/when-it-comes-to-the-truth-about-drug-addiction-scientists-are-breaking-bad/" target="_blank">here</a> and <a href="http://gawker.com/why-everything-you-think-you-know-about-crack-addiction-1336507720" target="_blank">here</a>). The version published in <em>The Atlantic</em> further enjoyed a promotional tweet by the famous Harvard psychologist Steven Pinker:
<br />
<blockquote class="twitter-tweet tw-align-center">
The Science of Choice in Addiction - Sally Satel - The Atlantic <a href="http://t.co/txYAoPjUC2">http://t.co/txYAoPjUC2</a><br />
— Steven Pinker (@sapinker) <a href="https://twitter.com/sapinker/statuses/385412176686878720">October 2, 2013</a></blockquote>
<script async="" charset="utf-8" src="//platform.twitter.com/widgets.js"></script>The articles possess the same basic implication - that the predominant view of addicts as zombie-like creatures bound by their compulsion is wrong, and now we have evidence to prove it. The problem with this, however, is two-fold: first, the view outlined above is <em>not</em> the predominant view of most addiction researchers, but a caricatured version of a more measured and nuanced conception (Marc Lewis's description of addiction as "biased choice" succinctly parses this quite well; he also has a <a href="http://www.memoirsofanaddictedbrain.com/connect/choosing-what-to-say-about-choice/" target="_blank">piece</a> tackling a similar subject to this post). The second part of the problem is that the conclusions of many of the media outlets vastly exaggerate the reach of the study they cite.<br />
<br />
The study in question is that of Kirkpatrick et al. (2012): <em>Comparison of intranasal methamphetamine and d-amphetamine self-administration by humans</em> - a title rendered sufficiently bland by its competitors in the media (<em>Gawker's</em> headline was <em>Why Everything You Know about Crack Addiction is Wrong</em>). The study's primary aims were to test the effects of different molecular amphetamines on cardiovascular health and psychomotor performance, as well as users' subjective experiences (i.e. ratings of mood change and behaviour towards each drug). <br />
<br />
The general procedure (of interest here) was as follows; participants were subjected to two different sessions on two different days - the first was a "sample" session in which participants were provided with samples of both drug and monetary rewards; the second a "choice" session wherein these rewards were actively chosen by participants during a computerised task. Depending on their choices, participants received either some ratio of drugs and money, or maximal amounts of either reward. Participants were also assigned to either a high value condition or low value condition; those in the former received $20 on sample days and had the option of obtaining $20 on choice days (given they chose only monetary options during the task), while those unfortunate enough to be assigned to the latter condition received only $5. (Drug doses were the same for each condition.) <br />
<br />
It was found that those in the $5 condition possessed no strong preference for a single reward, with only a slight choice tendency towards the money (59%). Those in the $20 condition, however, were far more likely to choose money over drugs, with 83% of options chosen being monetary. The authors concluded that when given a valuable-enough alternative, participants could be dissuaded from drug self-administration: a reasonable conclusion. The media then took this modest hatchback of a conclusion and inflated it to Ferrari-like proportions. The labelling of the media's conclusions as exaggerated is justified for two reasons: first, such significant conclusions are unlikely to ever be validated by a single study (this, as a rule, is not how science generally works). Second, such conclusions based on this particular study would be unwise given its numerous limitations.<br />
<br />
We can first consider flaws with the study's cohort. With just 13 participants, the study's sample size was small; but further, since the design was between subjects (meaning conditions are effectively analysed separately) this reduces the numbers further to just 6 and 7 participants in each condition. These numbers are minuscule. Moreover, all participants were male and self-selected - none had ever sought help for their drug use nor were they interested in receiving any - meaning that what we might have here is a particular subgroup of drug users with different goals, intentions, personalities and experiences with drugs, which do not apply to many others not in this group. Furthermore, the authors note that only three of the participants met the criteria for drug dependence - this is only 23% of an already tiny sample! Overall this means that any conclusions derived from this study cannot simply be extrapolated to clinical populations.<br />
<br />
There also exist problems with the study's design (given the conclusions of the media). Since participants were automatically supplied with drugs on "sample" days, we cannot make any solid deductions about whether the same results would be garnered in periods of abstinence. Also, given that many of the participants may have been occasional users, a hit of meth every few days may have been ample, meaning the only real option to go for would have been money anyway. This also means that the employed strategy of many may have been to sequester funds for purchase of drugs after the experiment was over. However, this is unlikely to have been the case - at least if the plan was to spend the monetary rewards on meth. The values of the drug and monetary rewards over the course of the study were well matched ($60-$80 and $100, respectively), and given the average dose of meth (250mg) will set you back around $80 on the streets of New York (the study's location), the participants would receive the same amounts of meth whether they obtained it from the researchers during the study or from Walter White afterwards (<em>Breaking Bad</em> references are still going strong, right?).<br />
<br />
However, another small problem appears when we consider that these participants were also users of cocaine and marijuana, both of which are cheaper than meth (marijuana substantially so; see Table 1).<br />
<br />
<table border="1" cellpadding="0" cellspacing="0" class="MsoTableGrid" style="border-collapse: collapse; border: currentColor; mso-border-alt: solid windowtext .5pt; mso-padding-alt: 0cm 5.4pt 0cm 5.4pt; mso-yfti-tbllook: 1184;"><tbody>
<tr style="mso-yfti-firstrow: yes; mso-yfti-irow: 0;"><td colspan="2" style="background-color: transparent; border: 1pt solid windowtext; mso-border-alt: solid windowtext .5pt; padding: 0cm 5.4pt; width: 462.1pt;" width="924"><div align="center" class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: center;">
<span style="font-family: "Cambria","serif"; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Illicit drugs prices in New York City: 1lb<o:p></o:p></span></div>
</td></tr>
<tr style="mso-yfti-irow: 1;"><td style="background-color: transparent; border-color: rgb(0, 0, 0) windowtext windowtext; border-style: none solid solid; border-width: 0px 1pt 1pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt; width: 231.05pt;" width="462"><div align="center" class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: center;">
<span style="font-family: "Cambria","serif"; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Meth<o:p></o:p></span></div>
</td><td style="background-color: transparent; border-color: rgb(0, 0, 0) windowtext windowtext rgb(0, 0, 0); border-style: none solid solid none; border-width: 0px 1pt 1pt 0px; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt; width: 231.05pt;" width="462"><div align="center" class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: center;">
<span style="font-family: "Cambria","serif"; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">~$15,000<o:p></o:p></span></div>
</td></tr>
<tr style="mso-yfti-irow: 2;"><td style="background-color: transparent; border-color: rgb(0, 0, 0) windowtext windowtext; border-style: none solid solid; border-width: 0px 1pt 1pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt; width: 231.05pt;" width="462"><div align="center" class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: center;">
<span style="font-family: "Cambria","serif"; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Cocaine<o:p></o:p></span></div>
</td><td style="background-color: transparent; border-color: rgb(0, 0, 0) windowtext windowtext rgb(0, 0, 0); border-style: none solid solid none; border-width: 0px 1pt 1pt 0px; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt; width: 231.05pt;" width="462"><div align="center" class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: center;">
<span style="font-family: "Cambria","serif"; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">~$12,000<o:p></o:p></span></div>
</td></tr>
<tr style="mso-yfti-irow: 3; mso-yfti-lastrow: yes;"><td style="background-color: transparent; border-color: rgb(0, 0, 0) windowtext windowtext; border-style: none solid solid; border-width: 0px 1pt 1pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt; width: 231.05pt;" width="462"><div align="center" class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: center;">
<span style="font-family: "Cambria","serif"; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Marijuana<o:p></o:p></span></div>
</td><td style="background-color: transparent; border-color: rgb(0, 0, 0) windowtext windowtext rgb(0, 0, 0); border-style: none solid solid none; border-width: 0px 1pt 1pt 0px; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt; width: 231.05pt;" width="462"><div align="center" class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: center;">
<span style="font-family: "Cambria","serif"; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">~$2,000 - $3,000<o:p></o:p></span></div>
</td></tr>
</tbody></table>
<em>Table 1</em>: The links for these estimates can be found in the reference section.<br />
<br />
This means that the above strategy would still be valid when applied to these other drugs, and so again any inference that these results alone show the way forward in how we treat addicts is mistaken. Finally, the doses used in this study were 5-20 times lower than average street use, and simply scaling these results upward and assuming they would remain the same is bad practice.<br />
<br />
So as we can see, though this is by no means the worst study you're likely to find, the conclusions made by the media extended far beyond the study's grasp. This is a shame, not just because scientific research has been misrepresented - though this would surely be enough - but also because there are other <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.2006.01311.x/full" target="_blank">studies</a> out there which actually test whether alternative monetary reinforcers dissuade addicts' drug inclinations, and they support the results found here. Some might ask <em>"Then why write this article?!"</em> But to ask this question would be to miss the point. The point here is not to say that offering alternative reinforcers to addicts could never work, but to highlight the fact that this lone study could never provide the evidence necessary to show that it does. In the progress of science, evidence is more often than not carefully accumulated, not acquired in its entirety. The media would do well to remember this.<br />
<br />
<br />
<u><strong>References:</strong></u><br />
<br />
Hser, Y. I., Huang, D., Brecht, M. L., Li, L., & Evans, E. (2008). Contrasting trajectories in Heroin, Cocaine and Methamphetamine use. <em>Journal of Addictive Diseases</em>, <em>27</em>, 13-21.<br />
<br />
Kirkpatrick, M. G., Gunderson, E. W., Johanson, C., Levin, F. R., Foltin, R. W., & Hart, C. L. (2012). Comparison of intranasal methamphetamine and d-amphetamine self-administration by humans. <i>Addiction</i>, <i>107</i>(4), 783-791.<br />
<br />
<a href="http://ecstasy.com.ua/the-properties-of-methamphetamine" target="_blank">http://ecstasy.com.ua/the-properties-of-methamphetamine</a><br />
<br />
<a href="http://www.narcoticnews.com/Meth-Prices-in-the-United-States-of-America.php" target="_blank">http://www.narcoticnews.com/Meth-Prices-in-the-United-States-of-America.php </a>Jay Joseph Duckworthhttp://www.blogger.com/profile/17356742306120820200noreply@blogger.com0tag:blogger.com,1999:blog-2317081029927093289.post-48633230684922996052013-10-14T05:13:00.003-07:002013-10-14T14:22:06.269-07:00Empire of the Mind<span style="font-family: inherit;"><span style="mso-bidi-font-family: Arial;">Empire of the Mind is a blog for people interested in psychology, whether psychologists themselves, scientists in other fields, or simply interested members of the public. The (probably somewhat optimistic) aim is to give an entertaining yet insightful look into the world of psychology and neuroscience. It covers quite a broad range of topics, with each of the blog's central themes isolated to individual pages which can be accessed via the tabs at the top of the page. To help readers navigate to topics of interest, each of the tabs are explained below.</span><br /><br /><strong><span style="mso-bidi-font-family: Arial;">Media Missteps:</span></strong><br /><o:p> </o:p><br /><span style="mso-bidi-font-family: Arial;">A look at various media misrepresentations of psychology and neuroscience, from newspapers and books to movies and TV. </span><br /><o:p> </o:p><br /><strong><span style="mso-bidi-font-family: Arial;">Critical Reviews:<o:p></o:p></span></strong><br /><br /><span style="mso-bidi-font-family: Arial;">A sceptical look at new research findings and blog posts from other psychology-centred authors.<o:p></o:p></span><br /><br /><strong><span style="mso-bidi-font-family: Arial;">My Research:<o:p></o:p></span></strong><br /><br /><span style="mso-bidi-font-family: Arial;">Posts related to my research. This includes descriptions of experiments in progress, recent results I've obtained and links to publications. </span></span><br />
<span style="font-family: inherit;"></span><br />
<span style="font-family: inherit;"><strong>Addiction Group:</strong></span><br />
<span style="font-family: inherit;"></span><br />
<span style="font-family: inherit;">Links to all of the latest research from the University of Liverpool Addiction Group.</span>Jay Joseph Duckworthhttp://www.blogger.com/profile/17356742306120820200noreply@blogger.com0