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"Drug overdoses were the leading cause of increased mortality in midlife in each population, but mortality also increased for alcohol related conditions, suicides, and organ diseases involving multiple body systems."

Perhaps we can start treating addiction like a disease and not a moral failing?

I don't think addiction is a disease or a moral failing, it's more a product of the environment of the addict.

Case in point: up to 20% of soldiers in Vietnam were addicted to heroin during the war, and up to 40% had tried it, but when they came home only about 5% remained addicted. See: https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1521-0391....

There are many factors in a person's life that lead to addiction, and while I'm not an expert, I think there needs to be a formalized system of getting people out of the environments in which they became addicted as part of the treatment.

> formalized system of getting people out of the environments in which they became addicted as part of the treatment.

Isn't that what going to rehab is about? For those who can afford it atleast...

I guess I mean, changing environments after rehab.

The problem many recovering addicts face, is that even if they get to go to rehab, they return to the same stressful home life/enabling friends/underemployment that pushed them into addiction in the first place.

I guess what I'm saying is that rehab without job training/support and relocation assistance of some kind is doomed to high recidivism. (If the word recidivism applies to rehab, not sure if that's proper usage here)

> I don't think addiction is a disease or a moral failing, it's more a product of the environment of the addict.

Diseases are very often products of the environment.

That's very true. I guess I'm referring to "disease" in a too-narrow pathological sense.

We're all complex open systems so of course disease and environment are intertwined, I just find that when lay-people like me refer to addiction as disease, they typically mean a narrow definition of "let's find a problem with your brain that we can fix," and not much else.

Maybe I was addressing an imaginary counter-argument!

This is the kind of snide remark that drives me crazy.

Treating addiction as a disease will not fix anything except put more money in the drug companies pockets (which is why they push this narrative). Treating diseases is amazingly more ineffective than preventing the disease.

Preventing addiction is not something we like to talk about. Our drug companies and government have been amazingly complicity in pushing pain standards that have killed hundreds of thousands. Similarly we have so called "treatments" for depression, ADHD, and other newly-popular diseases that may in fact be making things worse long term, but the government has done nothing to make sure that long term outcomes are better but has been run by Big Pharma for a long time.

treating addiction as a disease has brought us drugs like chantix (varenicline), among others. it is very profitable for them to first create an addiction, then offer the solution.

i agree that the drug companies will continue to profit from pitching addiction as a medical problem, and it is very true that preventing addiction is far easier than treating it.

regrettably, preventing addiction is not something our society is geared up for. if anything, we are in the mode of causing addictions for the purpose of profit -- whether by social media or by opiates. our society inflicts enormous pains on people and drives them to escapism via drugs as a result. the rat park experiment is very enlightening in this regard: https://en.wikipedia.org/wiki/Rat_Park

the treatments for depression are, unfortunately, a way of compensating for the deprived and stressful environment in which we live. it is this environment that i suspect is the root cause of the widespread prevalence of depression, though there is probably a sizable population of people who develop depression regardless of their environment. antidepressants are intended to help the latter group, but are used for both the former and the latter.

as we know, the antidepressants don't definitively solve any underlying neurobiological problem, though they may save a few lives and empower some people to change their life's circumstances and ultimately recover. is it better for someone to be reducing their pain using antidepressants rather than street drugs? certainly.

you mention ADHD, but i think your angle on it isn't exactly in the same bucket as depression. people with ADHD are at extremely high risk of addiction. i imagine that if we could reliably treat ADHD and increase awareness regarding the disorder's attendant comorbidities, we would be preventing many addictions before they could develop.

That is a very good point. When you talk about preventing addiction, are you referring to the war on drugs or providing quality of life improvements that might steer people away from drugs in the first place?
> When you talk about preventing addiction, are you referring to the war on drugs

When you talk about preventing systematic racism against blacks, are you talking about the Atlantic slave trade? Because the the relation between the latter pair is about the same as that between the former.

I would just like to see more education about addiction. Society definitely doesn't handle addiction properly, but it's not a disease and it's not a clear cut moral failing (though it takes strong morals to overcome). The roots of addiction go deep and many people don't properly understand that the roots have to treated lest the addiction sprout again in some form.
> but it's not a disease

In what precise way is it not?

Addiction is a disease. And I also think it can be a moral failing to play around with addictive substances. I say this as one who has a long family history of addiction and who has struggled with his own addictions: I was wrong to get involved with certain things.

When I reached out to my parents my (normally quiet and ultra-supportive) mom’s first words were, “I thought you were smarter than that.” And her next sentence was, “How can we help you?”

Once someone is trapped preaching ceases to be helpful. But preaching the morality of good decision making to avoid the pitfalls of vice can help prevent people from entering the funnel.

My view is unlikely to be popular on this board, but I think your point is a classic example of the either-or fallacy.

“Playing around with biohazards is bad. Oh, the bottle broke and you’re sick? Well... let’s get you to the hospital.”

“Drugs and alcohol have the potential to absolutely destroy your life and the lives of people you love. You’re an alcoholic? Let’s get you the help you need.”

Your description is very different from treating it as something to punish people for, which is what usually is meant with "moral failing" in this context.
> I was wrong to get involved with certain things

IMO you're judging yourself harshly. For most people who use drugs and/or alcohol a hangover is the worst consequence. If you're around other people using them and they're having fun I expect it's very hard to stay conscious of the fact that the risks are elevated for you, given your family history

> Perhaps we can start treating addiction like a disease and not a moral failing?

Curious. What advantages would that change of mindset bring?

If people are not deemed to be bad/evil/degenerates because their brain chemistry demands they seek out a certain drug, then we as a society can re-organize our efforts to helping them be safe and recover more quickly. We can provide clean needles and addiction treatments, rather than jail cells and criminal records.
Handling opiod addiction as a disease starts with decriminalizing the drug. (It should remain a controlled substance, of course).

The next step is to make appropriate doses available to addicts at a cost that eradicates the illegal trade. These doses are administered in clinics, under the supervision of pharmacists and other professionals. This enables addicts to live their lives. The doses are offered in liquid form, not tablets. When mild and pure doses are readily available, the incentive to steal fentanyl and cut it with baby formula goes away.

The next step is to encourage addicts to reduce their dosages and do other things to get their addictions under control.

Along with all this, provide strong continuing education to working medical professionals about pain medication and addiction. Make it a point of pride among them to avoid getting their patients addicted.

The present system in the US is dominated by 12-step thinking. https://www.projectknow.com/research/alcoholics-anonymous-12... While 12-step programs help a great many people, they have two problems.

1. The whole "nature of our wrongs" approach (moral failing).

2. The cold-turkey approach, which ignores the possibility of physiological help to get through physiological withdrawal, and makes relapses more likely.

Other paths to treating addiction besides 12-step-centric ones are worth trying.

Portugal is following this path with reasonable success.

In the US it's hard to make this change. More than a century of systematic demonization of addicts has made the "moral failing" approach the norm. And, successful decriminalization of opiods will throw a lot of law enforcement people out of work.

But it's still worth trying, especially considering how many other things aren't working.

It would be good to compel Purdue Labs and other opiod-peddling drug marketers to disgorge some profits to help finance experiments in this kind of thing.

The idea (I'm not particularly for or against) is that a victim of a disease can seek help & compassion; a morally bankrupt individual can find only scorn. Then it just comes down to whether you think help & compassion helps people right their ways more than admonishment & ostracism.
Why not both?
Because treating something like a moral failing is hardly helping anyone. Instead treating it like a disease means actually helping people in the situation they are.
> Perhaps we can start treating addiction like a disease and not a moral failing?

My friend who died from heroine overdose.

Here is his story, my friend got banned from online forums. In his opinion, he was banned for posting political rants. And moderator told him, do not do this here. So, he felt is not accepted in the community and got addicited to heroine.

These days, some moderators think they are lords of the universe and ban anyone like a robot.

It's failure of the soceity in part of his personal failure.

Addiction progresses like a disease, but begins as a moral failing. If I were to begin using heroin today, it would be by conscious choice, not because there's something wrong with my body.
It certainly feels to each person that they are in control of their decisions. However, there is strong, convincing evidence that people are easily influenced and often times can be led to make bad decisions. This is true for all of us. I’ve never had an inclination towards drugs but I know this has much less to do with my morality or lack of personal failings and much more to do with luck.

It’s ok to view addicts with grace and be thankful that the forces that led them to addiction did not affect me thusly. My failings happen to occur in other areas of life.

What if you were injured on the job, were prescribed opioids by your trusted physician, became addicted, had the prescription ended, then what? If you've not dealt with opioid withdrawal, you may easily say you'll stop there. However, many cannot, and move into black-market pills ($$), then into heroin ($), and that's where the fentanyl comes in with numerous added deaths in recent years.
Many diseases are the results of choices, often the culmination of thousands of little, to use your words, "moral failings". Cancer, heart disease, diabetes and even suicide attempts fall under that umbrella.

I don't see the need to make a distinction here, unless your intention was to imply something that was unsaid?

Could it be, at the onset? The decision to take drugs? Where one is suffering from depression or some form of chemical imbalance? Or, could one be prone to risk taking behavior? Is the precursor to risk taking behavior, biochemical?
Except for 12 year old Travis whose mom introduced him to heroin and now he can't stop. Travis has morally failed because he is doing drugs and it's all his fault.
It’s gotten to the point where doctors are no longer strongly pushing meeting all the RDIs for eating healthy and exercising if you’d otherwise be working, since (absent other risk factors) how much earning power you have at 35 is a better predictor of your total life expectancy than whatever amount of permanent damage you’d do to your body before then.
That sounds very anecdotal.
Almost definitely. I'm seeing this move toward pragmatism across medicine though. E.g. even my infant daughter is getting recommendations from her pediatrician that don't adhere strictly to the AAP or WHO guidelines.
Umm, isn't that why they're called guidelines instead of rules or laws? They're a generalized solution for the populace at large which may be adjusted for individuals as their needs differ. Comparatively, BMI is a guideline and body fat/cholesterol/activity levels/nutrition intake are the more important drivers to health that determine what changes need to be made for improvement.
We are too stressed in the US. Our companies don't treat employees like people, treat them like automotas. No paternity leave, very very little maternity leave. 2 weeks vacation. We are working too hard and burning our selves out.
> we are working too hard and burning our selves out.

Are we? Every single medium-big sized company I've worked was overstaffed to the gills, you could fire about 40-60% of ppl and no one would notice.

If you work for any online ecommerce company you would notice that their main shopping time is during work hours.

i agree regarding the widespread overstaffing and the ubiquitous e-loafing, but the issue is more complicated than that.

it's possible to not do very much work at work but still suffer from the bad lifestyle factors:

sitting all day, being constantly stressed regarding stability, being constantly reminded of your social status (or lack thereof), not having enough time after work to do errands or take care of children, not having enough unbroken chunks of vacation time without having to answer an email or do any work, not getting paid enough to comfortably cover all the bills, being reminded of how hard it will be to make ends meet if you get seriously ill, etc.

even if these excess employees were actually doing necessary work all of the time, these problems wouldn't go away. they might even get worse.

Ironically it's more stressful for someone to do less work and put on a farce. He's always worried he'll be called out and have nothing to show for it.
Not necessarily a contradiction; many of those people will be diligently producing the appearance of work, which is most simply measured by long hours.
agreed.

it turns out that when people are treated like capital, they depreciate, much like other forms of capital.

Ah, but if you put enough together, they start making more on their own!
Sounds like Americans have had a marked decrease in mental and physical health over the time period analyzed. (1999-2016).

I think maybe easier access to healthcare, mental and physical, could help?

Also a lot of this might be signs of an overworked populace? (How many jobs are people working to make ends meet? Do the ends meet after all the jobs are worked? etc). So we should probably look at that as well.

But I think one of the biggest things we should take a long hard look at is our lifestyle. (I know that work hours are a part of that, but I broke that out on its own because it's at least a bit easier). What are we doing during our days? (A lot more screen time these days than there were pre 1999. How many hours do people spend checking reddit/facebook/TinderInstaChat? What impact does that have on physical and mental health?)

What are we eating and drinking? (This might have something to do with it?)

Are there any environmental factors that have arisen as a result in subtle lifestyle changes during the indicated time period?

Etc etc etc.

I guess, in short, I think a comprehensive trend such as the one outlined in the study likely requires a comprehensive look at possible causes.

> I think maybe easier access to healthcare, mental and physical, could help?

I agree with almost everything else you have said. But this line has got to go from the most-common-reply-to-this-problem.

I think it's a huge canard, probably the biggest political canard in existence today, and there are far bigger problems that this presumption (that healthcare is what's needed) masks.

Just as you say, I think there are deep-seated problems with how we structure our society/lives/even just getting about, how we eat, how we are able to (or not) meet new people and create chance encounters, that do not happen for the vast majority of people. Problems that are new in the post 1800's world and seem to only be getting worse.

I do not think the solution is contained anywhere near "more healthcare." Our use in the US already tremendous, more than most countries and most time periods ever in existence. I do not think the solution is "more mental healthcare", unless you mean actually creating and inhabiting communities again, instead of living from space bubble to space bubble. I do not think that's what people mean when they say mental healthcare. Usually they mean hire more therapists instead of create more places where it's easier to have friends meet and people congregate.

It doesn't even pass the sniff test. If the answer was really more healthcare: When has the US consumed more healthcare (mental or physical) than today? In fact if some amount of healthcare = dispensing pills, it seems like this report proves that too much healthcare is one of the biggest contributors to this mortality problem.

I really wish people would stop repeating that statement and start focusing more on what else has gone wrong. I think you are on to something important with the rest of your post, but its too easy for people to drown it out with demanding that "healthcare" do something. I think it's a shame.

Everyone's overthinking this: I think the answer is as simple as "9/11 and its global aftermath." What do we have? Wars, astounding national Debt, and the political divisiveness and uncertainty being fueled by the several crops of politicians. Well, that and the natural cultural end-game of global banks looting western civilization.
It almost seems like you didn’t read the paper.

It shows that the vast majority of the trend is attributable to drug overdoses, and then suicide and alcohol related liver disease are also significantly increased. Other diseases have also increased but are dwarfed by these factors.

So your conclusion seems like it throws away the actual insights provided by the research.

I wish it called out the difference between males and females. Is the trend mostly with males?
Actually, it specifically said that the overdose trend is more pronounced in females.

But what's not said seems to also be relevant to the issue you raise. For instance, for suicides, I'd wager the trend is more pronounced for males. (Though they didn't call that out. So that may or may not be the case).

But whether those in poor mental health are committing suicide, or seeking escape in opioids and other drugs, the final result was clearly the same. Doesn't really matter if you're male or female.

I read through the methods, and didn't see any attempt to correct for changes in the age composition of the population ranges. From my minimal familiarity with it, it doesn't sound like it invalidates the results, but it does tend to complicate them.

http://andrewgelman.com/2015/11/06/correcting-rising-morbidi...

http://andrewgelman.com/2015/11/06/age-adjustment-mortality-...

Did you read the methods, though? This is the first sentence:

Methods We examined age adjusted mortality rates based on the 2000 US standard population for 1999-2016 using the Underlying Cause of Death Detailed Mortality database in the Center for Disease Control and Prevention’s Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) platform.27 The agency’s methods for age adjustment are described elsewhere.

Yes, I read this sentence.

This is a problem with common ways of doing age adjustments.

The issue is somewhat subtle: if you partition people into age bands (45-56), at different times in history, the average person who is in that age group may be older or younger, because different years had higher or lower birth rates. This was a particularly strong effect when the baby boomers were in the 45-56 age range.

My initial comment was that this paper didn't make clear whether they addressed the issue. Having now followed through to the CDC link they have, it looks like it also uses somewhat coarse age bands.