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The growing scientific case for using Ozempic and other GLP-1s to stop addiction -https://news.ycombinator.com/item?id=40357196
https://recursiveadaptation.com/p/the-growing-scientific-cas...
> The consistency that I'm hearing from all across patient groups is gain of control, whereas previously, there was a loss of control… All of a sudden they're able to step back and say, 'oh, well I had this shopping phenomenon that was going on, gambling, addiction, or alcoholism, and all of a sudden, it just stopped,'
- Dr. Gitanjali Srivastava, Vanderbilt Medical Center
Fiddling with our "reward centre" does not seem like it can have a localised effect to a couple of unwanted behaviours. I'm not sure we are braced for how widespread or impactful the other consequences might be especially if a vast percentage of the population take them life.
For example, could they significantly change voting preference? Why wouldn't they? Do we not respond to political messages with our "reward centre"? Will we find political charisma more or less entrancing? Will we find calls for vengeance and punishment more or less attractive? Does tinkering with desire and reward dull our emotional response? Will we find compassionate appeals to help less fortunate more or less attractive? Does "enhanced control" manifest as a political preference for rational altruism or as machiavellian selfishness?
If taking a substance removes our desire to shop, then I'm sure there are powers in this world that will stop it from happening.
It strikes me as an ideology of hatred towards humans to argue against something so incredibly beneficial for the individual in this way. Yes, being free from addiction will certainly change the way people vote and their political outlook on life, just as exercise and eating healthy will do.
It is not selfish to improve yourself and it does not make you sick that somebody else is healthy. You know very well that people who dedicate themselves to being healthy are very eager to help others as well.
Don't worry: we mostly don't have a "reward center". If you're thinking of ventral striatum, it does something more like motor vigor. https://mitpress.mit.edu/9780262044059/vigor/
Personal anectode / not a doctor / YMMV.
I started Ozempic about 3 months ago, prescribed by a nutrologist, first with the minimal weekly dose of 0.25mg, then 0.5mg, now back to 0.25mg to control my glucose levels (prediabetes). During this period, I lost about 25 lbs, which is fine (but I lose weight easily, just by exercising, so I wouldn't call this phenomenal by itself).
The biggest difference I felt was indeed in gain of control, being more aware of my body and living in the moment. I've been practicing meditation for a long time, and what I can say is that the drug keeps you in a medidative state for longer (most of the week).
The result is that I still like fatty foods and sweets, but I don't crave them. Binge eating has stopped, and all addictive/obsessive behavior, including social network / news sites / porn consumption has stopped.
I am normaly hyperfocused, but my standard m.o. has been peaks of absurdly high performance interspaced with a hiatus of low productivity/creativity. Right now, the the ability to focus on what I want/need to instead of what serendipity brings my way has been awesome.
Huh. sounds more like an ADHD drug than a weight loss drug.
I actually hate eating and routinely have conflicts of "I'm physically hungry but have no appetite". I wonder if Ozempic would make me gain weight.
Curious if you consumed alcohol or any other substance before and if you still do after?
Makes sense to me. Im on keto/carnivore, when im strict w no cheating. After about 2 weeks im reorganizing and less interested in videogames. I think, sugar is stressing out the whole system
Root cause is a hormone imbalance, GLP-1 agonists patch a reward center in the brain (scoped to addiction, whether that be food, drugs, alcohol, gambling, etc).
What’s interesting is that we’re about to have a large scale natural experiment around addiction and whether it is chronic due to brain chemistry or more willpower as GLP-1 agonist uptake rate skyrockets in the general population (which should result in addiction reduction at scale).
It may be that it flattens all affect rather than addictions in particular. "Ozempic personality" is associated with anhedonia.
https://www.healthline.com/health-news/ozempic-personality-c...?
I deal with my own addictions but I'm not happy about the prospect of trading them for less joy of life in general.
For me Ozempic isn't an option because it's associated with reduced gut motility and I already have serious problems with that.
Frankly, I'm enjoying life a hell of a lot more now that my feet, knees, and back aren't killing me all the time.
The article you linked actually gets into that, in a quote from a doctor disputing the validity of the concept of "Ozempic personality".
Is hedonism joy?
People get so upset when confronted with the fact that humans, like all animals, are largely clockwork machines driven by chemistry.
Like it or not, you (yes, you) are a slave to your internal chemistry. No amount of willpower or happy thoughts will cause your hormones or neurotransmitter levels into the homeostasis you want. If your chemistry is off, your physical and emotional behavior will be off.
You are a sentient pile of molecular machines ticking along because the chemistry happens to work out. There is nothing special about you, you're exactly like every other plant, animal, and fungus on this planet.
So yes, plenty of mental, behavioral, and physical disorders arise from chemical imbalances. If you take this fact, consider what happens when you indtroduce foreign and extremely powerful chemicals into such a complex organic system.
If you come back with the assertion that addiction is a question of willpower, you didn't understand the assignment.
Yes, deep down it is all chemical processes but complex systems can develop emergent behaviors that can not be explained by looking at the lower levels.
A few days ago, this article[0] has been discussed here on hacker news. I shows how the naive theory of chemical imbalances can be harmful for treating Schizophrenia.
> In this vision, mental disorders were best understood as brain dysfunctions that could be traced to abnormal genes. Schizophrenia stemmed from an imbalance of the neurotransmitter dopamine. Depression was a serotonin imbalance. Bipolar disorder was a lithium imbalance. ADHD a deficiency of norepinephrine. These conditions, of course, could be triggered by life events, but they were ultimately biological. It was a reincarnation of the ancient Greek humoral theory, which saw the various forms of madness as imbalances in the four humours: blood, phlegm, yellow bile, black bile.
I recommend reading the whole thing but I really liked this part of linking it to the Greek humoral theory.
In the end of the day, there isn't any scientific evidence that it is "just chemical imbalances". The reality is more complex. Medication has its place and it absolutely can help but it just one tool to help patients.
There is a good reason the brain disease narrative is so tempting: It avoids having to look at environmental factors. It avoids having to talk about how society is driving people mad. It is easier to say someone's brain is broken than having to talk about societal issues. It also leaves patients powerless, giving them the idea that their brain is just "broken" and they can't do anything about it instead of giving them the tools to create a better life for themselves and others.
In the end of the day we are all a parts of interdependent systems that form society. Mental health issues are more often than not societal issues more than individual issues.
[0] https://aeon.co/essays/how-the-psychiatric-narrative-hinders...
> Like it or not, you (yes, you) are a slave to your internal chemistry. No amount of willpower or happy thoughts will cause your hormones or neurotransmitter levels into the homeostasis you want. If your chemistry is off, your physical and emotional behavior will be off.
It’s not that simple – there are feedback effects. There is plenty of evidence that thoughts shape chemistry as well. This is why therapy works, for example.
edit: This is also why you can “hype yourself up” or “talk yourself down”. Those are thoughts/words leading to measurable physical and chemical effects in the body. You really can raise your cortisol just by thinking the right thoughts
Like it or not, you (yes, you) are a slave to your internal chemistry. No amount of willpower or happy thoughts will cause your hormones or neurotransmitter levels into the homeostasis you want. If your chemistry is off, your physical and emotional behavior will be off.
Define, "off". Who gets to decide what's normal?
Everything we do impacts brain chemistry. By extension, non-pharmaceutical interventions can change brain chemistry. The mistake is in the notion that said chemistry is invariably statically a-priori "wrong" in every single case people get addicted or depressed (it becomes as such), and acting as though addiction in itself is only relegated to the realm of the abnormal, that "normal" human beings can't be addicted.
And yes, notwithstanding that there are cases where people are, owing to genetics, more susceptible to x/y/z, or where interventions can be insufficient. But that's the first line of defense, and should be.
There's a lot of anecdotes surrounding this but a popular one is rate of morphine abuse during and after the Vietnam war. The rates plummeted.
A really good book on the topic of addiction is the Biology of Desire by Marc Lewis.
I would also caution against any conflation of environmental and behavioral intervention as "willpower". These are not the same things (you didn't say they are, but you didn't give any credence to intervention). Willpower may be highly overrated, but ultimately, you can't "force" someone to rehabilitate in any way shape or form. They have to want to, they have to make the choice, and commit. As for therapy/rehab, some of these have been thoroughly studied. Interventions help (and therapy such as CBT or 3rd-wave CBT), considerably.
I believe there is some truth to what you are saying, but this interpretation is far too extreme. We do not fully understand how any animal works, let alone humans.
> No amount of willpower or happy thoughts will cause your hormones or neurotransmitter levels into the homeostasis you want.
Behavioral-only therapies are effective, even if they're not as effective as we'd like. We have the ability to modulate our own chemistry.
"Hypocrite that you are, for you trust the chemicals in your brain to tell you that they are chemicals. All Knowledge is ultimately based on that which we cannot prove."
- Mickey Mouse
How do you explain some of the most drastic and lasting changes in many peoples lives coincide with wanting them very deeply? We just happened to want most what we achieve?
Your internal state is influenced by your environment, and you have the power to control your environment. The idea that you can't control your internal emotional state because it's governed by chemicals is absurd. People do things _all the time_ because it makes them happy.
Not necessarily against your thesis but it promotes a vibe that isn’t solution oriented. For me, I notice that when I meditate that my social media addiction has less of a grip on me because my baseline attention and (seemingly) executive functioning are better.
Now, you could argue “yea, behavior can change neurotransmitters and it is in my framework so what is your point?”
The point is that your framework can easily be take the wrong way to that we are more or less all doomed, us being mechanistically no free will slaves. At least, that’s the vibe that I feel when reading it. I think I am not alone in that.
And while I agree with that, I’d argue that focusing on optimistic interpretations of your framework is much more fruitful. Optimism being characterized as a bias towards positivity while still staying fully grounded in reality.
It has only been recently that I started to do some hardcore meditation (2 hours per day). I kickstarted it by making a deal with a friend: for each hour we miss, we pay 100 euros to each other. So far I haven’t missed anything and am on day 4. I am low-key dreaming of solving meditation motivation and spinning that up into a startup as it has been the biggest problem in my life (one could imagine it being my biggest problem since my username is related to metta meditation).
That’s only hard to accept when it’s about something we’d prefer to take credit for, or what someone else has done that we’d prefer to blame them for.
When I do something bad, then it’s time for “hey, I’m just a pile of chemically influenced meat.”
When my friend overdosed on heroin she was revived with two doses of naloxone. Her drinking was under control for about 2 weeks. Naltrexone is very similar to Naloxone, and is FDA-approved to help people with opioids and alcohol use.
https://en.wikipedia.org/wiki/Naltrexone
The Sinclair Method uses naltrexone to help people get their alcohol use under control:
Naltrexone is at the heart of the Sinclair Method (TSM)
for Alcoholism. When you take Naltrexone prior to
drinking, it blocks endorphins, the naturally occurring
opiates in the brain, from being released when alcohol
is consumed.
When the endorphins are blocked, there is no “buzz” or
rewarding experience, and the alcohol doesn’t make you
feel the pleasure that drives you to drink excessively.
Over time, your brain learns not to associate alcohol
with pleasure, resulting in reduced cravings and
improved control over alcohol use. Naltrexone must be
taken at least one hour before your first drink.
Very cool, thanks for sharing. Describing it another way:
The goal is to deassociate alcohol with pleasure. One way to do this is to abstain for a long period of time so that the association gradually weakens, but 1) this requires constant willpower and 2) takes a long time for the association to decay.
If you instead take a pill that blocks the pleasure from alcohol consumption, you can undo the association very quickly and with basically 0 willpower (it’s not like your brain currently has an association between taking the pill and experiencing pain).
I have no experience with alcohol dependence, but this is a great confirmation of the reinforcement patterns of the brain.
I don't understand at all what is this "buzz" that people talk about that causes alcoholism. When I drink too much, I feel dizzy and I hate that feeling of not being fully in control. When I do drink moderately, it's because the drink tastes good, period. Some mocktails taste just as good as the real alcoholic version so I'll opt for that. Wines have a much more complex profile so grape juice isn't a substitute, but still I enjoy the taste and aroma of wines, not that it gives me any pleasurable "buzz" (whatever it is).
Its very convenient for big pharma to lump all addictions to a chemical imbalance in the brain.
We have been here before with the first wonder drug "Prozac" back in the late 80's. A cure all for everything.
yet there was no research to support those chemical imbalance claims.
I worked as a methadone dispenser for 15 years and this is not my experience of addiction.
There is no chemical or hormonal imbalance when you become addicted to drugs that relieve you from the psychotic hallucinations you experience daily or the young woman who did not know her boyfriend was a heroin addict and started chasing the dragon with him or even the young stressed out mother who's husband has abandined her who has been told by endless TV advertising that a glass of red wine a day is good for you or the young man who has sufferred sexual and psychological abuse as a child who drinks to forget.
Wegovy a cure for everything from the flu to cancer.
> Its very convenient for big pharma to lump all addictions to a chemical imbalance in the brain.
This is also a lazy argument that tends to get a strong response without being meaningful. It's basically equivalent to saying "it's convenient for big speaker that all music requires sound". Chemicals are the regulation system in most living things. They are necessary and that can't be ignored. Some can be artificially manipulated to get desirable responses, hence "chemical imbalance".
I'm also not sure how your examples are relevant to your argument. #1 is a pretty exceptional case, but hard to take as a representative argument. The rest are all secondary effects from human interaction, drugs are incidental to the outcome you describe.
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Ultimately, humans respond to positive and negative reinforcements. This is a pretty primal level thing and can be seen in nearly every other living thing. Do X, receive Y, reinforcement. Living things need these positive reinforcement cycles to thrive. For the most case, these are "mundane" things like talking with other humans, eating normal meals, drinking water, etc, etc. They guide people to keep doing things that make them feel good, even if those things are overall harmful.
GLP-1 drugs are rather exceptional as they seem to temper people's responses to certain reinforcement. Particularly, addictive or addictive-like reinforcements, like overeating. Whether this is the result of a "chemical imbalance" is pretty much just semantics. It's not really meaningful.
They also have some strong, powerful secondary effects, but really only by happen-stance. Patients who eat less, are less likely to develop diabetes. Patients who have less desire to drink alcohol are less likely to develop cancer. Patients who have less desire to do drugs are less likely to become addicts, etc, etc, etc.
But everything a living creature does is chemical. Even the process of that young man who has suffered sexual and psychological abuse as a child, that brain that can't stop ruminating can't stop ruminating because of a chemical feedback loop that the brain is doing natively.
When my mom got diagnosed with pancreatic stage 4 cancer and I couldn't cope with it and I was already in a drug explorer mindset at the time and I started taking her opioids and I became quite addicted (no she wasn't deprived of any of her medications she was fine). This whole process absolutely was chemical imbalance. Years before in high school I stopped taking all of my ADHD medication and then started spiraling out of control dabbling in all sorts of disassociative and psychedelic drugs. If I didn't stop taking my Adderall in high school I wouldn't have gone down any of that path.
A lot of disease has environmental and intrinsic causes.
Categorizing disease as having a set of characteristics in the body doesn't make it solely rooted within those characteristics.
I think there will always be a desire to solve disease with a single pharmaceutical, as that would be an incredible thing. However the existence of drugs that do not work for everyone doesn't necessitate that the signals for characterizing disease are off or that a pharmaceutical isn't useful to some people.
Organisms are incredibly complex, even those composed of relatively few cells. Thinking there is always some magic bullet to address a biological or emergent phenomenon is probably not the answer, but neither is being dismissive of treatments that don't meet that criteria.
I had a drug and drinking problem in my 20s and the cause of it was just me dealing with unresolved childhood trauma from an abusive parent and years of bullying that left me unable to interact with other human beings unless I was drinking. Taking MDMA (and the self reflection and opening up to people) is what finally let me process it and move on with my life and quit taking drugs and drinking and still be able to function like a normal human being, but I want to be clear -- I didn't have a chemical imbalance that MDMA "corrected". I was abused for years and had trauma to deal with because of that, and MDMA just temporarily opened my eyes to a new way of viewing the world that wasn't clouded by that trauma.
Thinking of all psychological issues as if they're some innate property of the person and not something that's a consequence of _their environment_ is going to lead to bad results. People see that drug addicts are unhappy and think the drug addiction is causing the unhappiness, but that might be reversing cause and effect. Happy people with satisfying lives don't generally develop debilitating drug addictions, and I think that just making people satisfied with living in a bad environment is a bad solution. It's bad for them as an individual and bad for society. Sometimes the solution for depression and other stuff is to just get your shit together and take control of your life -- and drugs can have a role in getting you off your ass and doing something, but I worry about just pushing them as a long term permanent solution.
chemical imbalances are very real, its just that the cures dont actually help you alleviate those imbalances. On a intuitive level, it makes sense that any chemical that you introduce to your body (be it drugs, or even just food) creates an imbalance that your body tries to compensate for, since your bodys main goal is normalizing its internal state. Most pharma drugs are band aids, which dont actually cure the root causes, leading to dependence in order to feel normal. even just an unhealthy lifestyle causes chemical imbalances, it doesnt have to be a drug you take. the detrimental part of this is that some drugs can temporarily cover up the imbalances as well, which leads to people reaching to these drugs to 'feel normal' - this leads to what we would call addiction, because addicts mostly self medicate. the drug doesnt have to be the root cause.
There’s a big difference between psychological addiction and physical dependency.
At some point during addiction your body depends on these substances to operate and stopping becomes much more difficult. Alcoholics need to taper or take benzodiazepines to quit otherwise they may seize or die when going through withdrawals.
I would say anyone who begins drinking to numb the feeling of withdrawals (morning or middle of the night) is beginning the journey of serious alcoholism. That’s not really a craving it’s more of a need at that point.
Both play a role. But in my experience for most common addictions the psychological component is the bigger issue. The physical dependency can't be ignored and is something you have to manage when quitting, but what brings people back is usually the psychological addiction.
Of course this depends on the addiction. With some hard drugs or coffee the physical dependency is the bigger factor
I can only speak for my own drinking, but tapering off is as natural as other forms of long term planning. The drinking tends to fall off the calendar like anything else.
I'm not saying alcoholism isn't a thing, but the way some people discuss alcohol seems like they're blaming the symptoms rather than the root cause. Low impulse control, not seeking novelty enough, and otherwise living a messy life is the actual problem.
More attention should be paid to why people start using in the first place. If someone is using a substance to feel good, it’s because they don’t feel good. Obesity, same thing; people are eating their feelings.
Big pharma expanding psychiatric propaganda.
Yet another attempt to categorize addiction into a simplified form that can be treated with $MY_SOLUTION.
Good luck with that.
Addiction is a failure of education.
If our schools were better, and more honest, we would explain the biology of addiction well enough that no one who understood the lessen would become addicted.
The lesson is simply this: Any pleasurable experience results in a normal and natural down-regulation by the body of the receptors that are responsible for that experience.
It is impossible to repeat the same dose (whether drug, food, roulette wheel, or skydiving) and have an equally intense experience until enough time has elapsed that the receptors have been up-regulated back to their original levels.
The hallmark of addiction, "chasing the dragon", is therefore pointless and quickly becomez harmful.
The other important lesson, of course, is that quality control is essential. Variations in the drug (concentration, impurities, improperly attached bungee cords) are solely responsible for the non-dragon-related dangers.
By this logic, no emotional arguments should work because they are logically incorrect, right? (This is your first point)
However, since you seem to like logic, let us take it to the extreme - Can you do anything you like? Because, the thing you like will become your dragon.. (This is your second point)
Drug impact variations can also happen because of the state of your body. Hence nothing can be done and should be done (Third point).
Now I am wondering if I am responding to a robot :(
One of the defining aspects of addiction is the inability to stop doing the harmful act despite knowing it's harmful.
> we would explain the biology of addiction well enough that no one who understood the lessen would become addicted
This is such a misunderstanding of how humans work. Knowing that something will hurt you has never, in the whole history of humanity, stopped some people from trying that thing. And many of the people who do things that they know will hurt them are the exact ones who pushed further than others.
> If our schools were better, and more honest, we would explain the biology of addiction well enough that no one who understood the lessen would become addicted.
Are you asserting that no nurses, doctors, or social workers are affected by addiction? All would have learned its mechanisms during their professional education.
> The lesson is simply this: Any pleasurable experience results in a normal and natural down-regulation by the body of the receptors that are responsible for that experience.
This lesson is reductive and dangerous. It ignores that some responses are stronger than other responses and that some of those strong responses are stronger than conscience willpower.
I was taught this in school, as well as all of my classmates. And I, and many of them, have still had struggles.
While I agree that education would reduce addiction, it would not cure it as you’ve suggested.