"Talks a good game about freedom when out of power, but once he’s in – bam! Everyone's enslaved in the human-flourishing mines."

Against Rat Park

I.

Rat Park is a famous study in which lab rats were kept in a really nice habitat that satisfied their every need. Contrary to the usual results with lab animals, scientists couldn’t get these happier rats addicted to drugs. Researchers concluded that drug addiction, far from being the simple biological story everyone assumed it was, was really a just coping mechanism for intolerable social situations. Rats stuck in terrible cages get addicted to drugs, as do humans in terrible slums. But give them other opportunities for happiness, and the problem disappears.

This has become a sort of popular legend. From HuffPo: The Likely Cause Of Addiction Has Been Discovered, And It Is Not What You Think. From Intellihub: Rat Park Heroin Experiment Shows Cultural Roots Of Drug Addiction. There’s even a Rat Park Comic and the inevitable Trump Could Learn From The Rat Park Experiment thinkpiece.

Rat Park lead researcher Bruce Alexander eventually developed a whole alternative theory of drugs, provocatively titled The Myth Of Drug-Induced Addiction. He notes that there are lots of people who take supposedly-addictive drugs without getting even the least bit addicted to them. The particular example he gives are patients who were prescribed cocaine for chronic pain, did well on it, and never abused the cocaine or escalated the dose. Even people who use it illicitly are unlikely to get addicted: “American and Canadian population surveys indicate that merely having used cocaine is associated with less than a 10% chance of having it as often as 100 times”. He uses this to draw a picture where cocaine isn’t really “addicting” per se, but people can repeatedly use drugs for “nondeterministic” reasons; for example, “certain people choose an addictive lifestyle as a lesser evil in desperate circumstances”.

Alexander makes his point with cocaine, but others working along the same lines have an impressive collection of related anecdotes. In World War II the Nazis, never ones to pass up unethical applications of science, put much of their army on methamphetamine to give them more energy and stamina. After the war, these soldiers reintegrated back into German society without much trouble; there was no epidemic of continuing meth addiction. Likewise, people worry about the opiate epidemic today, but only about 10% of people put on opiates for chronic pain become addicted; most take it as prescribed and then stop without any problems when their pain gets better. Even more obviously, the vast majority of social drinkers stay social drinkers; only a fraction become alcoholics. So – Alexander and his followers would tell us – clearly non-biological variables must be involved. And Rat Park tells us what those variables are: the social factors that make the difference between a terrible life and a flourishing one.

II.

How does this argument fare?

Two studies (1, 2) tried and failed to replicate the results. Another two (1, 2) tried and mostly succeeded. There’s some concern that the rat strain involved might have various substrains that the different experiments didn’t control for. But a result that can’t survive a change in rat substrains has pretty dismal prospects for applicability to humans.

There seems to be a more general problem with rat drug experiments in general, where everyone in the field realizes they can sometimes throw out weird results. The Drug Monkey blog says that rats self-administering cocaine is the best-replicated result in drug abuse science, but also that it can be screwed up by anything from the diameter of the cocaine infusion catheter, to whether the experimenter is wearing a dirty vs. clean lab coat, to who you buy the rats from.

So let’s take a step back and look at 13th century Mongolia.

Who had the best life – the happiest, most fortunate, most blessed existence in all of history? I don’t know, but Ogedei Khan had to be in the top ten. The son of Genghis Khan, he took over his father’s empire and continued the family tradition of conquering things. China, Korea, and Eastern Europe all fell to his armies; for over a decade he conquered and conquered without suffering a single serious defeat.

For his enjoyment, Ogedei built the Tumen Amgalan, “Palace Of Myriad Peace”, 2500 square meters in area. It had:

64 pillars, a green-and red-tiled, Chinese-style roof, and green-tiled floor built over a heating system. When the khan met important visitors he sat at a great throne with one staircase for ascending and another for descending. Inside the palace was a fountain, designed by a French jeweler captured in Hungary, that embraced a silver tree that spewed out mare’s milk from a lion’s head and wine, rice wine, mead and airag from from four snake heads. At the top was an angel with trumpets that blew and dispensed more drink.

We don’t know the exact size of Ogedei’s harem, but his father Genghis kept about three thousand concubines, and his successor Kublai had seven thousand, so if this kind of thing increases linearly, we can estimate Ogedei had somewhere around 5,000. The records, shamefully imprecise, tell us only that he took “pleasures in the company of beauteous ladies and moonfaced mistresses”.

Of his own character, Wikipedia says:

Ögedei was considered to be his father’s favorite son, ever since his childhood. As an adult, he was known for his ability to sway doubters in any debate in which he was involved, simply by the force of his personality. He was a physically big, jovial, and very charismatic man, who seemed mostly to be interested in enjoying good times. He was intelligent and steady in character.

So if you had to be a historical figure, you could do worse than Ogedei Khan. I mention this because he was a raging alcoholic who drank himself to death.

History tells us that the Khan’s advisors were so concerned about his drinking that they staged a sort of medieval Mongolian intervention, begging him to cut down. Ogedei was moved by their plea, and swore to limit himself to one cup of alcohol a day from then on. But he later regretted his pledge and ordered the imperial artisans to create a purpose-made giant cup that could hold as much alcohol as he wanted. He died at 55, probably of alcohol poisoning. His successor, equally blessed, also became an alcoholic. So did several other members of the Khan family, rich and victorious all.

So: How do we square the idea that addiction is a disease of deprivation and misery with the addiction of the Great Khan, happiest and most fortunate of men?

And what about the American Indians during colonial times? Not the ones who were being displaced and uprooted by white settlers. The ones who were still participating in their traditional lifestyle with only distant relationships with the British colonists. Without wanting to go full on noble-savage or minimize the difficulties of a hunter-gatherer lifestyle, they seemed to have things pretty good. We know that Indians taken captive by white men found European civilization intolerable, but whites taken captive by Indians enjoyed Indian life so much that they often refused to return home once rescued. Most of the testimony that’s come down to us from historical Indians and their white observers indicates that their lifestyle was, if not perfectly idyllic, at least enviable.

But the early Native Americans were famously susceptible to alcohol, far more so than whites, so much so that entire tribes were destroyed by alcoholism epidemics and the ones that weren’t had to ban the substance as an existential threat.

And if neither Khans nor Indians seem happy enough, what about celebrities? They seem to have it all – wealth, power, fame, groupies. But they still get addicted to drugs at a high enough rate to produce six seasons of Celebrity Rehab With Dr. Drew (key quote: “In May 2013, Pinsky announced that season six was the final season, as he was tired of the criticism leveled at him after celebrities he treated had relapsed into addiction and died”).

Can you invent some convoluted definition of flourishing which classifies stormtroopers, chronic pain patients, and enriched-environment-rats as flourishing, but Khans, Indians, and celebrities as deprived? Maybe. But by that point the Rat Park hypothesis is becoming unfalsifiable; any seemingly flourishing group that becomes addicted will just lead to more twists in the definition of “flourishing”. Better to just admit people can succumb to addiction no matter what their apparent happiness level.

III.

A more responsible look at addiction would emphasize that it’s at least half genetic:

In a lot of cases, we know the genes involved. They’re usually not surprising: smoking is linked to genes for nicotine receptors; alcoholism is linked to genes for GABA receptors. In other cases, we don’t know what genes are involved yet, but we know from twin studies that they have to be there somewhere.

Some of these genes seem to differ across populations. The best-studied are different frequencies of ADH and ALDH polymorphisms. Asians in particular tend to have some very protective alleles here in a way showing signs of recent selection, with the extreme version being the alcohol flush reaction seen in about a third of East Asian individuals. There’s a plausible story where cultures that have lived with potent forms of alcohol for millennia have evolved some level of biological resistance to it, whereas cultures that didn’t get it until recently (like Mongolians and Native Americans) are worse off.

This lets us accept some of the Rat Park data without having to swallow their conclusion. Yes, most chronic pain patients can take opiates for years and never get addicted. Most cocaine users experiment once or twice but don’t end up as cokeheads. And most social drinkers never become full-on alcoholics. But this is a consequence of genetic luck, not enriched vs. less-enriched environments, and we don’t have to throw out the entire concept of “addictive drug” just to deal with it.

But does environment affect addiction at all?

This is really hard to solve empirically. You can find a lot of pictures like this:

But the studies that produce these kinds of graphs aren’t great. For example, they can’t rule out that drug addicts become poor as a result of their drug addiction. Even if they look at people born in poverty, they can’t rule out genetic confounds – ie your parents abuse drugs and become poor, and you’re born in poverty with the genes for drug addiction.

Sometimes they come up with different answers depending on how you define the outcome of interest. Maybe poor people have more drug abuse but rich people have more drug dependence, or vice versa. In one study, rich people were more likely to have dangerous drinking-related behaviors, but only because they were more likely to drink and drive because they were more likely to own cars. Often rich people will be found to abuse one drug more, and poor people another, with unclear overall significance.

The better studies seem to have confusing conclusions like that of Patrick et al:

Smoking in young adulthood was associated with lower childhood family SES, although the association was explained by demographic and social role covariates. Alcohol use and marijuana use in young adulthood were associated with higher childhood family SES, even after controlling for covariates.

This seems a lot more subtle than the Rat Park model of “only people in bad environments ever get addicted and addiction is entirely an environmental condition.”

IV.

But at some point you have to try using common sense, and common sense tells me that unhappy people use drugs more than happy people. At least, individuals seem to use drugs when they’re least happy, and be best able to quit when everything is going well.

A lot of the genes, neural correlates, imaging findings, [insert science term here] of addiction involve the reward system, especially dopamine and the nucleus accumbens. The story goes something like “drugs are really rewarding, your brain does whatever gets it lots of reward, therefore your brain compels you to do drugs”.

And without having a great scientific explanation of exactly how this works, I think that having other sources of reward besides drugs available can attenuate this effect. Nothing in real life is ever going to be quite as rewarding as heroin. But if having a happy family and doing meaningful work and so on are, I don’t know, a quarter as rewarding as heroin, then maybe you have an opportunity to use “““willpower””” to force yourself the rest of the way and take the only-a-quarter-as-rewarding option. If you have a crappy life that doesn’t have any other source of reward at all, then all the “““willpower””” in the world won’t save you.

Imagine someone engaged in a scummy job they feel bad about doing, like spammer or tobacco advertiser or bioethicist. They want to quit, but they get a really good salary – let’s say $100,000/year – and they’re not sure they can do without the money. If they’ve got another wholesome option that pays $50,000, maybe their conscience is strong enough to help them make the leap. If their only other option pays $15,000, that’s going to be a lot harder. This is how I think about drugs too.

The rest of this post, Parts I II and III, is pretty sound science. This part is just my toy model. But it seems like something of this sort has to be true. Society and genetics have to interact somehow, and this seems about as good a way as any.

But remember: society is fixed, biology is mutable. You should work on the super-long-term project of improving society because that’s the right thing to do. But if you want to fight drug addiction now, in an effective way with some hope for helping today’s addicts, the best choices are still deregulating suboxone and legalizing research into psychedelic therapy.

This entry was posted in Uncategorized and tagged , . Bookmark the permalink.

Leave a Reply

190 Responses to Against Rat Park

  1. mrolympia2007 says:

    ~88% of americans with Schizophrenia smoke cigarrettes.
    ~20% of americans smoke cigarrettes.
    ~13% of americans with OCD smoke cigarrettes

    Are people with Schzophrenia suffering much more in life than non-schizophrenics? Yes, Rat Park wins.
    Are people with OCD suffering less than the general population? Not even close, Rat Park makes no sense here.

    This is one interesting example I found about people with hard lifes being less likely to be addicted to certain drugs, also the cheer number of Schizophrenics smoking makes me think that the model hard life = more drugs isn’t even close to the big picture, 88% is an absurd number, I’m sure there must be some sort of neurochemical explanation for this.

      • mrolympia2007 says:

        wow, never knew Scott made a post about this. Thanks, will read now.

      • Yashabird says:

        Interestingly, we treat dementia with Donepezil, which stimulates nicotine receptors in a complex way.

        It may be splitting hairs to call schizophrenia “dementia praecox”, but there is certainly cognitive deterioration, and nicotine holds a special place in our pharmacopoeia as the one drug most consistently shown to boost cognitive performance.

        https://www.scientificamerican.com/article/will-a-nicotine-patch-make-you-smarter-excerpt/

        Given the cognitive challenges that schizophrenics face, it honestly baffles me why we don’t push nicotine patches harder towards them. You don’t even have to tell them to stop smoking; just tell them the nicotine patch will help with foggy thoughts and irritability.

        • mrolympia2007 says:

          Interesting, I spent last night reading about Schizophrenia and smoking and I came up with a hypothesis:

          1)Smoking seems to have positive impact upon negative symptoms of Schizophrenia.
          2)Negative symptoms generally occur before positive symptoms manifest.

          Maybe young schizophrenics are using smoking as self-med for the negative symptoms, those symptoms alone would be much more difficult to be identified as schizophrenia symptoms and probably people would just think the young guy is “weird”.

          3)Smoking seems to be much less helpful for positive symptoms of schizophrenia

          This indicates that nicotine is probably not a very good antipsychotic, but as you mentioned the cognitive effects are well known.

    • Protagoras says:

      It seems like the more complex theory (perfectly compatible with the influence of genetics on addiction rates) is that people take drugs mostly because they seem to help or at least make them feel better about something, often some problem or problems they have; a lot of it is self-medication, as they say. Often there are side effects, sometimes worse than whatever problem the drug is supposed to be helping with, of course, which is why we consider addiction a problem. But of course there will be variation in who gets addicted; it’ll be much more likely among those with the problems for which that drug is relevant. Schizophrenics all smoking suggests nicotine sometimes helps with that, I’ve heard that there’s research showing people with untreated ADD are more likely to be stimulant addicts (stimulants, of course, help relieve ADD symptoms), and I expect there are similar patterns for other drugs. So the obvious conclusion is that it isn’t having a hard life in general that produces drug use, but rather it is having specific problems that the specific drugs help with. The alcohol case seems to indicate that biology affects how much the drugs “help,” and that being biologically resistant to being “helped” by alcohol also makes one less likely to use it (which is unsurprising on this model).

    • Yosarian2 says:

      OCD may not be a good example, since the act of smoking may conflict with some of the more common obsessions or compulsions that some people with OCD suffer from (cleaning, intrusive thoughts about accidentally starting a fire, ect.)

      An interesting side note here though is that a high percentage of adults with ADHD are heavy users of stimulants, including nicotine, caffeine, ect. It’s often thought that they may be self-medicating, so that might relate to some of the kinds of drug use we’re discussing here.

  2. John Schilling says:

    One thing worth noting is that “addiction” has at least two definitions. There’s the technical, medical definition involving tolerance and withdrawal, and the colloquial definition that involves failing at major life goals because of improper and excessive use of [whatever]. Scientific studies are mostly going to focus on the former, celebrity anecdotes the latter, and population-level observations will probably be somewhere between the two.

    I don’t think it changes your conclusion, but I also don’t think we can be highly confident that e.g. Ogedai Khan was an alcoholic in the medical sense. He could have just really liked drinking and not liked being told what to do; the latter is I imagine a common failing for personal sovereigns.

    • millericksamuel says:

      The fact that he promised to give it up and then was unable to follow through seems to suggest addiction. Also the amount of the Mongolian royal house that killed themselves with alcohol is terrifying. To me it is unlikely to not be addiction.

      • MartMart says:

        Unable or unwilling to?
        He may have not like being told what to do by anyone, including his past self.
        Alternatively (although less likely) he may have told his advisers what they wanted to hear so they would leave him alone.
        Or, he wasn’t convinced to drink less because he was asked nicely, but by some underlying argument (Drink less and you will be a happier, better ruler. Drink less and your horses will win all the races). So he tried drinking less, found that he wasnt any happier and his horse lost, so he went back to drinking.

        It’s really hard to say anything definitive about someone several years dead. He might not even have been all that happy for all we know.

        • Watchman says:

          Where does the story about him promising to drink less come from? Much of history was written by writers with moral agendas, and very little by neutral observers (how things change if you look at today’s media…), so a story of this nature could be an attempt at damnatio memoriae or a parable about the evils of drink. I don’t know this field of history well, but a story such as this has all my alarm bells as to whether we can accept it at face value tingling.

          It is also worth noting that for all their wealth, the Khans did not rule an ordered and structured society – or perhaps more accurately, whilst they ruled over many ordered and structured societies, the Mongols were not one. Steppe warlords required to keep their followers loyal and close (when not on campaign), and this was normally done by feasting and bestowing gifts, and receiving gifts and hospitality from followers in return. As the ruler had to be seen as the centre of the feast, the bestower of food and gifts, then the requirement to drink if alcohol became a norm of the feast would be automatic. And whilst followers would come and go from the cycle of feasting, the Khan was probably either feasting or campaigning, as would beother members of the family if they were building up a powerbase. So the high alcohol consumption might not be addiction so much as necessity.

          To try a rather simplified comparative model, in relatively similiar societies in seventh-eleventh (I originally said tenth, then remembered the unfortuante Harald Harefoot) century Britain, and, if we trust the sagas, contemporary Scandinavia, where a culture of feasts was maintained, there is a notable tendency for kings to die relatively young, which could perhaps be explained by similiar issues. Where more complex court systems developed then alcoholic bounds were replaced by formal bounds on a feudal model, and kings seem to live longer – the ninth-century Carolingian rulers mostly made good ages if they didn’t die violently for example – and a model of a king with restrained appetites appears as a living ideal in western European thought for the first time since the Romans. It could be that having to drink to cement your power could be bad for your health. This may not be a shocking medical insight though.

        • John Schilling says:

          “I promise to drink only one cup of wine per day”, enter ginormous megacup, is A: almost too good a story to be true, so casting suspicion on the rest of the details and B: if true, sounds very much like a snarky rebuttal to an unwanted intervention. Or it could be backsliding by someone who honestly couldn’t quit but didn’t want to break his word. No way to tell at this late a date and through 13th-century Mongolia’s historical recordkeeping.

          But if Ogedei is the weakest part of this argument, and Ogedei plus modern celebrities not that much stronger, there’s still all the e.g. Plains Indians who seemed to be quite happy in all the usual senses when firewater showed up.

          Still, I don’t want to completely throw away Rat Park. because I do think it explains some aspects of e.g. the current “opioid crisis” better than anything else I’ve seen. So maybe we need to look at alternate definitions of not-quite-happiness that rats in parks have but celebrities and Khans don’t, and almost certainly we need to consider that all of this is massively confounded with differences in genetic susceptibility (whether rat or human).

          • theredsheep says:

            Wiki mentions that Ogedei’s brother may have killed himself in some bizarre Mongol shamanic ritual intended to save Ogedei’s life. I might have become a drunk too, under such circumstances. The American Indians might simply be the result of having no “drinking culture.” If there’s no accepted cultural model for healthy drinking behavior, alcohol consumption might well follow an unhealthy pattern; didn’t opium have a similar hammerblow effect on the Chinese? As for celebrities, well, they have a rather peculiar culture built on a combination of high pressure, constant attention, and self-centeredness. There are confounding variables here.

  3. Jliw says:

    I think your intuition is basically right.

    I wasn’t able to stay away from opioids, for all the years and years of trying every rehabilitation scheme out there, until I got Suboxone. The difference was stunning — years of constant failure, then bam: instant, and apparently permanent, success. As if it was the easiest thing in the world.

    The only temptation came when I was low, failing in other areas. Some months later, in a better time — looking at my wife and the cats as we planted an herb garden together — I thought “no way is it worth losing this.” Pleasure in another area, especially a “wholesome” one, has been my strongest defense after the buprenorphine.

    Yeah, remembering a few of the “perfect post-morphine moments” has been able to make me pine every once in a while; but a pleasure half as strong can be twice as good if the details are consonant with my values.

    • Jliw says:

      Note: family is all very educated and totally into delayed gratification and self-denial. I was treated with love and care. I don’t know what happened with me.

    • Dog says:

      I’m also an ex opiate addict, and I’m not from any kind of disadvantaged background. My parents were loving and successful, I went to a good school, had plenty of friends, etc. I think an orientation towards others is what keeps many people from addiction, whether that is the desire to be a good friend / partner, fear of social disapproval, etc. Considered purely from the perspective of the individual, drugs can be way more rewarding than any alternative, at least at first. My personality is such that I’m not very motivated by social mores, so at the time I didn’t have much incentive not to just pursue hedonism.

  4. blacktrance says:

    Can you invent some convoluted definition of flourishing which classifies stormtroopers, chronic pain patients, and enriched-environment-rats as flourishing, but Khans, Indians, and celebrities as deprived? Maybe. But by that point the Rat Park hypothesis is becoming unfalsifiable; any seemingly flourishing group that becomes addicted will just lead to more twists in the definition of “flourishing”.

    That’s a problem if you do it ad hoc, but regardless of the addiction results, I expect Khans and celebrities to be pretty unhappy. I don’t know where Ögedei ranks by blissfulness of existence, but it’s low enough for me to pity rather than envy him. While it’s obvious that poverty and powerlessness are really bad, their extreme opposites aren’t that great, either. Wealth rarely becomes bad per se, but at the point where you’re choosing drinks for your four-headed fountain, it’s not doing much for you. And the badness of holding power isn’t only that it can be misused on others, but also for its effects on its holder. Do you think you’d be happier if, by some weird circumstance, you became absolute dictator of the US? It might seem nice as a vague fantasy, but if you think about it in detail, it’s obviously terrible (unless you can safely resign). Ayn Rand was right when she wrote that “A leash is a rope with a noose on both ends”.

    This unquestioned connection of wealth and power to happiness is why we need virtue ethics.

    • Jliw says:

      I can see it for our hypothetical U.S. dictator, but not celebrities. They can take their ball(s) and go home, with all their accrued fame and wealth.

      • blacktrance says:

        They can, and I expect the ones that do are happier, but we hear most about the ones that don’t.

      • actinide meta says:

        People who just want to be rich usually get rich without getting famous. People who become celebrities generally have to really want to be rich and famous. I think the latter desire takes a form in most people that’s fairly incompatible with enduring happiness.

        And kings, yeah, the sword of Damocles is kind of a thing.

        And frankly I strongly suspect that the happiness of hunter gatherers is overrated. But I think that one is probably mostly down to genes. The really vulnerable people in Europe presumably drank themselves to (reproductive) death long ago.

        • Jliw says:

          Excellent point RE: fame. I put myself in celebrity shoes without thinking about the sort of person who’d want those shoes in particular.

        • herbert herberson says:

          “I always want to say to people who want to be rich and famous: ‘try being rich first’. See if that doesn’t cover most of it. There’s not much downside to being rich, other than paying taxes and having your relatives ask you for money. But when you become famous, you end up with a 24-hour job.” – Bill Murray

    • Whatever Happened To Anonymous says:

      Wealth rarely becomes bad per se, but at the point where you’re choosing drinks for your four-headed fountain, it’s not doing much for you.

      That’s where you went wrong, it’s a five-headed drink fountain that will bring you true happiness.

      • Mary says:

        As long as you have real problems, you can convince yourself it’s the problems that make you unhappy. When you have no real problems, you face an existential crisis.

        • JulieK says:

          Your ordinary Joe can tell himself, “Okay, I’m unhappy, but maybe things will improve when I get that promotion.” A celebrity with a surfeit of fame and fortune asks himself, “Is this all there is?”

    • Eponymous says:

      My understanding is that happiness research (gag) has found a positive association between subjective and material wellbeing, at both the national and individual levels.

      I know there’s folk wisdom about celebrities being depressed, abusing drugs, and committing suicide; but I also know a lot of poor people who do those things too. I wonder how much of the impression just reflects that we hear about depressed, addicted, and suicidal celebrities in the news, while most people don’t talk about their friends and family who suffer those things; and also this plays into a preexisting narrative about nihilistic celebrities that developed due to jealousy.

      • INH5 says:

        I wonder how much of the impression just reflects that we hear about depressed, addicted, and suicidal celebrities in the news, while most people don’t talk about their friends and family who suffer those things; and also this plays into a preexisting narrative about nihilistic celebrities that developed due to jealousy.

        Well, celebrities do genuinely seem to have much higher divorce rates than average, so that’s at least one stereotype that holds up.

        • Watchman says:

          I always used to feel that that fact told us much more about the reasons for celebrity marriage rather than made a useful comparator.

          Now I am perhaps less cynical, I might amend that to telling us more about the pressures on celebrity marriage: it is a lot harder to hide an affair for example (I presume – never tried myself) if people keep taking photos of you whenever you’re in public; or a career which basically requires an unstable home life is likely to threaten relationships. I still don’t think it is a useful comparator though, because celebrity marriage is just an extreme end of a spectrum of marriage, not a separate (and easily defined) class.

          • It seems to me that “celebrity” in these discussions is focusing on film stars and the like, people who not only are famous but who depend on being famous for what they are doing. I suspect the results would be different if you looked at people who were famous more or less by accident–Einstein, a Nobel Prize winner, a very successful author.

            In the film star case, a lot of what looks like marital instability may be a deliberate policy designed to keep the people in the news, a sort of semi-real life soap opera.

        • Tibor says:

          I would not be surprised if these (as well as drug and alcohol abuse) were not substantially different for not so well-known actors and singers (which is what most celebrities are). I think it has less to do with them being famous than with being actors and singers – jobs which attract certain kinds of people who are definitely not a representative subgroup of the entire population.

      • Jayson Virissimo says:

        Celebrities aren’t just people that happen to have high material wellbeing though: they are people that have both high material wellbeing and fame. I think the latter conjunct is doing most of the work here.

        • baconbacon says:

          That sought out fame.

          • russellsteapot42 says:

            Most heroine addicts sought out heroine.

          • Conrad Honcho says:

            I’m not sure people understand how bothersome fame can be until they’re famous.

            For about 10 years I was a moderately famous photographer. At first nobody knew who I was, and conventions and tradeshows were fun. Learn things, check out new products and techniques, meet people, drink, party, great. Then I got serious about competition and started winning a bunch of awards, and was a “hot new thing.” Companies endorsed me, I went on speaking tours, etc.

            After that, conventions became extremely tedious. I couldn’t walk through a tradeshow without getting stopped every 5 minutes by someone I had never met but who knew all about me and my work and wanted to ask me questions, or just ramble on about their own work (as if talking to me was going to make my success rub off on them). And I had to be polite and chat with them because I didn’t want people whispering “man that Conrad’s a real jerk! I just wanted to tell him I liked his work and he was so rude and blah blah blah” because I heard that about plenty of other people. On the other hand, an awful lot of them were cute girls, so that made it much easier. Also taught me how important status is in terms of attraction. I was only famous at a photography event. Outside of that context I was a nobody, and the difference in the way women responded to me in a photography context versus a random public space context was extremely obvious.

            And during this time I thought about real celebrities who were famous everywhere and shuddered. I couldn’t imagine everywhere being like a photo convention, but that’s got to be what it’s like to be a movie star, only worse.

            Eventually I got bored and drifted away from the scene and settled down and had a family. I do not miss it.

          • @Conrad:

            I’m a big fish in two small ponds (SCA and libertarianism), so get to be a celebrity for a few weeks a year. Having lots of people want their picture taken with me is a minor nuisance (libertarianism–nobody in the SCA has yet proposed that we sit for a joint portrait), but other than that I don’t see the sort of problem you describe–why the difference I don’t know. And there is a real pleasure to the feeling of status. I can see the potential upside to the presence of admiring young ladies but I’m married and monogamous, which limits the potential payoff substantially.

            One distinction that may be relevant is between being famous and being admired. In my case and, from your description, yours, the attention reflects other people thinking well of you. It would be a lot less pleasant if, as is presumably the case for a lot of celebrities, it only reflected the knowledge that you were famous, or high status, or rich, or something else that didn’t feel to you like a confirmation of your value. I am considerably less pleased at attention from people who only know that I am my father’s son than from people who have read my books or enjoyed my talks or made use of my SCA research.

          • Conrad Honcho says:

            Maybe because photography was more like an industry. And a very ego and status-driven one at that. I got popular by winning awards (and being young while doing it), but there were a lot of people who got popular just because they got popular. By schmoozing, by networking, by self-promotion. It was very much like high school. Some people admired what you did, some what you had, and everybody wanted to know and be known by the cool kids because then you were one of the cool kids too. I don’t think you can “fake it till you make it” so much in libertarianism.

            Also, photography was/is full of “23 year old girls with a camera and a dream.” I don’t think that applies as well to libertarianism.

          • bja009 says:

            @russelsteapot

            Underrated comment, I had an excellent and contextually inappropriate laugh, thanks

    • vV_Vv says:

      I think that happiness is the wrong factor here, the right factor to look at is stress.

      People who are in objectively bad conditions: poverty, family disintegration, high-crime low-trust communities, etc. are more stressed than the average middle-class person, and are more at risk of developing addictions.

      But celebrities, dictators, warlords, and in general anybody in high-risk high-reward positions, even when they are highly successful by objective standards, are also more stressed than average. I don’t have data on incidence of addiction in these groups, but the stereotypes of alcohol guzzling and cocaine snorting celebrity or businessman is likely based on some statistical pattern.

      Of course genes also play a role, possibly a dominant one: not all poor people, or celebrities, or dictators became addicts, and some middle-class people with predictable boring lives do. But this does not exclude that at group level, stress can be a significant environmental factor.

      • cuke says:

        This is how I think about it too.

        People who are in early recovery, stress is often the trigger for relapse. People who have trouble with impulse control, generally have more trouble with it when under more stress.

        We might even think of boredom or social isolation as stressors (for rats too).

        So maybe: genetics plus stress plus access to addicting substance/habit.

    • Squirrel of Doom says:

      However many the riches and concubines, and however great the power, I think it just unavoidably remains true that it is really lonely at the top.

      In the sense that you have no equals. No peer group. All those people eager to please you and fulfill your every wish, but no one is a true friend, much less a love.

    • Dave says:

      What I teach young’uns that I mentor at work is that you shouldn’t try to maximize income. You should try to maximize income divided by the number of people who recognize you when you walk down the street.

  5. ajakaja says:

    I feel like any line of reasoning that includes ‘celebrities should be happy, yet look how often they…’ has to be flawed, because celebrities in many cases don’t seem happy at all. I mean, my view of their life is entirely anecdotal and curated, but there’s no shortage of examples of celebrities having breakdowns (or just being massively angry or broody people to begin with).

    If anything, I feel like many people, for lack of a clear understanding of what would actually make them ‘happy’, use materialism and hedonism and the like as a (mostly useless) proxy. And it’s not surprising at all that when this turns out to not be very related to ‘happiness’ at all (imo, it’s all about emotional and philosophical maturity), their emotional well-being doesn’t improve.

    I’ve never been addicted to drugs, but I have been pretty addicted to video games, and I think I have a pretty good understanding of what makes me do that. I tend to get into a state of anxiety about myself (such as being self-conscious about my behavior) for which my brain can’t comprehend a solution, so flounders and spins its wheels on neurotic thoughts (say, regret and self-loathing and avoiding socialization) which inevitably doesn’t help (because it’s not the actual problem) . When this happens I always find myself wanting to do mindless, simple, dopamine-rewarding things, usually self-destructively (say, all-night).

    It feels like a survival-mode response: maybe in prehistoric tribes my brain would induce behaviors that would actually solve social problems, but its methods don’t work in confusing modern society, so it flounders and ‘retreats’, and, with its high level functioning absorbed on a floundering loop, I seem to reduce to simpler reward mechanism behaviors. (at least that’s the truest-feeling model I’ve come up with so far)

    • INH5 says:

      I feel like any line of reasoning that includes ‘celebrities should be happy, yet look how often they…’ has to be flawed, because celebrities in many cases don’t seem happy at all. I mean, my view of their life is entirely anecdotal and curated, but there’s no shortage of examples of celebrities having breakdowns (or just being massively angry or broody people to begin with).

      This. And statistics seem to back this up. Just to give one example, one study found that celebrity married couples were twice as likely as non-celebrity married couples to get divorced over a period of 14 years.

      With the possible exception of “famous for being famous” people like Paris Hilton and the Kardashians, pretty much all celebrity jobs involve long working hours, lots of mandatory travel, and frequently stressful working conditions. And for the successful ones, including the “famous for being famous,” no privacy and an inability to go out in public without a significant probability of getting hassled by random strangers. Personally, I don’t envy the lifestyle at all.

      • Glen Raphael says:

        @INH5:

        Just to give one example, one study found that celebrity married couples were twice as likely as non-celebrity married couples to get divorced over a period of 14 years.

        If the context is movie/tv actors, they tend to live in L.A., where California divorce law says if a marriage lasts for ten years the higher-earning spouse can be ordered to pay alimony for as long as the lower-earning spouse needs it, aka potentially forever.

        “Movie star” being a high-variance career, chances are good that one-half of the couple has MUCH higher earnings and net worth than the other and the appropriate-seeming alimony payment to “keep up the living standard to which they have been accustomed” could be staggeringly high.

        As a result of this incentive discontinuity it is pretty common for L.A. celebrity marriages to break up as the ten-year anniversary is approaching.

    • jasonbayz says:

      The argument with celebrities is not “unhappiness does not cause addiction” but rather “poverty/unemployment/celibacy/no friends/ect” does not cause addiction. The point of “rat park” was that “the cage” was supposed to cause drug addiction so remove the cage and you remove drug addiction, but if “the cage” is just internal depression, what can you do about that?

      • rahien.din says:

        No, the premise of Rat Park is : we give the things to rats that genuinely make rats more fulfilled. Rat stuff. If they have more rat stuff, they won’t need drugs.

        Celebrity, instead, is a rat race. It’s not a state of fulfillment. The overall premise of Rat Park is unperturbed by drugged-out celebrities because celebrity is not to humans as rat stuff is to rats.

    • fortaleza84 says:

      I agree that life for a lot of celebrities is probably pretty miserable a lot of the time. Worrying about which parties you get invited to; watching your looks fade; seeing the younger actor/actress with the fresher face getting the part you wanted; having your spouse cheat on you; being lied about in the celebrity gossip press; etc.

      All of these things are pretty much par for the course in celebrity life and I would not be surprised to learn that they contribute to drug addiction among celebrities.

      Still, if you want to have a decent theory of life happiness versus addiction, there needs to be an objective way of measuring happiness. You can’t just look at addicts and come up with post hoc explanations for why they were unhappy.

      • Svejk says:

        I thought that “happiness” in the Rat Park experiment meant social and cognitive stimulation, security, and especially being embedded in networks of social support. Extrapolated to humans, rat park poverty would weight material deprivation less than a monotonous environment, social isolation, insecurity/hopelessness, and lack of rewarding work.

        Celebrity relationships are notoriously volatile and insecure, and their friend networks seem to be largely ephemeral and studded with predators and sycophants. When I think of groups that are “happy” in the Rat Park sense, I think of groups like the Amish, Mormons, and Adventists, people living on communal farms/homesteaders, and immigrant communities with a high proportion of intact families and extended family networks. In this model, someone living in semi-detached housing on a busy street who knows their neighbours could be “happier” than a wealthier exurbanite in a larger home with less regular social contact.

        This doesn’t explain Native Americans either, but I don’t think the theory has to exclude the influence of well-described genetic effects to have some utility. The non-replicability is a bigger concern.

        In one of his talks, the author of the study claims that data from western Canadian indigenous shows that alcoholism-like dysfunction occurred without alcohol when social and cultural networks were disrupted, and that when alcohol was introduced without cultural displacement its effects were much less pronounced (the author is Canadian). I do not have the data to evaluate this claim, but I think the author is unduly dismissive of genetic influences. I seem to recall that similar claims have been made about alcoholism in urban England during the displacements of the early industrial era, but I’ve never closely evaluated those claims, either.

        • fortaleza84 says:

          When I think of groups that are “happy” in the Rat Park sense, I think of groups like the Amish, Mormons, and Adventists, people living on communal farms/homesteaders, and immigrant communities with a high proportion of intact families and extended family networks

          I basically agree with you, but on the other hand it would not be to difficult to characterize such communities as oppressive and misery-inducing. I work in NYC and have a lot of contact with Orthodox Jews. There are a good number of reports of people, especially girls, who are unhappy due to the intense social pressure to conform to the community, to get married young to someone you don’t know very well, and have a very large number of children, etc

          I don’t know what their average level of happiness is, but the point is that you can always come up with a “just so story” after the fact so that all the evidence conforms to the hypothesis of happiness and addiction.

          If it turns out that there is a big problem with drug addiction in the Orthodox Jewish community, you could easily say “Of course there is, lots of them feel overstressed from child-caring duties, alienated by all the rules about dress and behavior, and depressed over the lack of freedom. Moreover, the low divorce rate just means that people are trapped in miserable marriages due to the stigma of divorce.”

          So without an objective and independent way to measure happiness, it seems like a difficult hypothesis to test.

        • Svejk says:

          As for the genetic factors, Scott mentions ADH and ALDH as showing signs of recent selection, but the key protective SNPs are only at high frequency in East Asia and related groups, and rare elsewhere (possibly due to the long history of rice agriculture and storage, where fermentation can first accidentally and later purposefully occur). These alleles are at very low frequency in Europe, and their frequencies in PNG and Australian aborigines, and many North American groups with relatively higher recent alcoholism rates are equivalent to those of Europeans. Rates of alcohol metabolism and related enzyme production are similar in European Americans and native Americans. So Europeans and Native Americans appear to be equally unprotected from alcoholism through these pathways.

          Many native American groups appear to have had traditional methods of preparing fermented beverages at about the strength of beer and wine from cacti, fruit, corn, and berries. For these groups, it was not so much alcohol but strong alcohol – and possibly a different drinking culture – that Europeans introduced.

          • Svejk says:

            There’s a plausible story where cultures that have lived with potent forms of alcohol for millennia have evolved some level of biological resistance to it, whereas cultures that didn’t get it until recently (like Mongolians and Native Americans) are worse off.

            While Mongolians have lower frequencies of the protective variants ADH2*2 and ALDH2*2 than Koreans or Han Chinese, they have higher frequencies of ADH2*2 than native Americans and Europeans, and similar or slightly higher levels of ALDH2*2. Interestingly, the protective/susceptibility association of ADH3*1 (the third allele from the linked paper) appears to vary between populations.

            Genetic influences on population differences in substance use will probably turn out to be complex.

          • herbert herberson says:

            Know of any easy-access resource (ideally a blog or something) that gives an overview of those genes?

    • akidderz says:

      Not a celebrity, but I live in NYC and have friends who are “successful” actors and actresses. Not mega-super stars, but they’ve been on TV shows that you’d know and do well enough that they no longer have other jobs. They are recognized when we go out, but never mobbed by fans.

      They’ve all had issues. Big ones.

      There is something about the discipline: the endless auditions and countless rejections that would drive anyone crazy. Your self-worth is measured in fame and yet you know, KNOW, that less talented people are succeeding because of some quirk of fate.

      • cuke says:

        This makes me think about research that’s been done on how unpredictable rewards (or punishments) are more stressful for people than reliable ones. The arbitrariness of rewards in that line of work seem like might be an ongoing source of stress that people would self-medicate for.

        There’s also a ton of drug use in certain sectors of the restaurant business — not related to unpredictable rewards, but to the late hours and to cultural factors that may also exist in acting — meaning lots of people around you are regularly doing drugs.

      • onyomi says:

        This is also true of academia and other “dualized” professions, but would-be academics don’t seem to suffer a particularly high level of drug addiction (they do drink a fair amount, though that includes highly successful academics).

        My personal best bet is that the qualities that lead you to want to go into acting and the qualities that make you prone to addiction are some of the same qualities. I have neither set of qualities, but I seem to see a strong correlation between the type of person who really likes to perform and be charismatic and the type of person who can’t seem to responsibly use, e.g. alcohol.

        • AnonYEmous says:

          Academics have tenure though, so I’d say that’s a significant mediating factor. Plus, a good idea is easier to identify and disseminate as opposed to a good ‘acting ability’ (and you’re competing with fewer people, probably – someone can’t come in off the street and write a paper, like they can audition for something)

          I seem to see a strong correlation between the type of person who really likes to perform and be charismatic and the type of person who can’t seem to responsibly use, e.g. alcohol.

          I feel like charisma is in a way just a hyped-up energy which you can see from, say, someone on cocaine as well. Maybe also alcohol?

          So maybe this is part of it; it feels good to have that frenetic energy, and then drugs give you more of it. People who have it already, or perhaps more importantly who enjoy being in an energetic state, are attracted to those drugs. Or maybe I’m just talking out of my ass ?

          • onyomi says:

            Academics have tenure though, so I’d say that’s a significant mediating factor.

            Tenure in academia is the equivalent of having already “made it” as an actor or musician. You’ve already landed your big part, sold your big song, etc. Even if you turn out to be a one-hit wonder, you have a sort of meal ticket you can rely upon to at least pay your bills, if not live the high life.

            The vast majority of people with academic aspirations, like the vast majority of people with aspirations to become successful actors and musicians, never get tenure, and even if they do, it tends to be after a decade or two of hard work. If the stress of that aspect of acting could follow actors even after they made it big, it could follow academics after they got tenure.

        • dndnrsn says:

          Academics drink a lot. Not drinking, depending on the field of study, can be a big networking handicap. However, if you’re an academic, you’ve spent a long time in academia – usually min 10 years in university in one form or another. And in that time you will probably learn to drink in such a way that you are going to be a functional alcoholic if you end up an alcoholic.

          • Academics drink a lot.

            Not my observation in U.S. Academia (economics, law, physics). I drink almost not at all and have never noticed it to be a problem.

          • dndnrsn says:

            Maybe it’s a humanities thing?

          • onyomi says:

            It’s not true in my experience that you have to be a functional alcoholic to succeed in the academic humanities in the US, though some subfields, like archaeology, are supposed to be especially bad…

            In China, if you’re a man on the other hand… (the culture of toasting and the equation of drinking more with expressing respect to those you’re drinking with and the need to rely on connections cultivated during such sessions can be intense).

          • dndnrsn says:

            I’m not saying you have to be a functional alcoholic – but if you are an alcoholic, you will probably be a functional one. I’ve seen more than one prof go through wine at a rate that’s certainly more than one needs to enjoy cheese, and in some fields I experienced second-hand, a huge amount of networking happened at the pub.

            Again, emphasis on the functional – the style of drinking is one where you consume a fair amount (consider that a “binge” is defined by medical types as 4 drinks for a woman or 5 for a man) while keeping your wits about you.

          • Controls Freak says:

            We used to say that PhD stood for “pretty hard drinker”.

          • Elephant says:

            “Academics drink a lot.” — Not in my experience (Physics, Biology, Chemistry; all U.S.). The chemists drink more than the other two, but I still wouldn’t call it “a lot” compared to most of society. And I’ve never seen not drinking as a networking handicap. (I’ve never seen anyone looked down on for drinking non-alcoholic things.)

          • Tibor says:

            Huh? I’ve never heard of that – at least not in maths in Bohemia and Germany which is the part of academia I am most familiar with.

          • dndnrsn says:

            Maybe STEM types really are morally superior. I was a humanities guy, and everyone seemed to like drinking; the heaviest drinkers (some first-hand experience, a bit more second-hand) seemed to be in any field concentrating on Medieval Europe. Profs holding office hours in the pub, that sort of thing. Thematically appropriate I suppose.

          • The only time I can remember encountering an academic context with lots of drinking was when I was giving some talks in Finland; the normal pattern seemed to be everyone getting drunk after dinner. I didn’t participate.

            But I assumed that was Finnish culture not academic culture.

    • Worley says:

      There’s also a strong selection effect, in that “celebrities” are often either actors or singers, and success in those fields tends to come from being able to express intense emotion. As Cintra Wilson said, “Good dramatic actors, who need to access a vast color wheel of emotion, are often intolerably volatile, hypersensitive nut jobs in real life. To inhabit characters of dubious artistic value, it is also helpful if they aren’t terribly smart. [Mickey] Rourke appears to have both of those qualities; it’s an equation that spells temporary magic on-screen and usually results in terrible suffering off-screen.”

  6. Augustina says:

    What about celebrities? They seem to have it all – weath, power, fame, groupies. But they still get addicted to drugs at a high enough rate…
    Perhaps some celebrities are not really happy with wealth, power, fame, groupies. They could have a hole that is never filled, but keep trying to plug it up with drugs and alcohol and whatever else they come across.

    • fortaleza84 says:

      I think that life for celebrities can be pretty difficult. I remember hearing Mark Hamil complaining about not being invited to certain bar mitzvahs and it occurred to me that this (getting invited to the important social events) must be a constant source of stress and worry for celebrities.

      Not only that, but if you are an entertainer, your physical appearance tends to be very important (certainly in acting and modelling, but even in music to some extent). And of course your physical appearance inevitably degrades with age. Especially for actresses, going from age 25 to age 35 (and then to 45) must be very difficult psychologically.

      That said, my guess is that the main factor is that drugs are very easily available in celebrity culture.

  7. Mary says:

    But the early Native Americans were famously susceptible to alcohol, far more so than whites, so much so that entire tribes were destroyed by alcoholism epidemics and the ones that weren’t had to ban the substance as an existential threat.

    I have heard that part of the problem was that they assimilated to an existing concept they already had: mind-altering drugs. The point of drinking was to get dead-drunk, not mildly buzzed. Spirits were better than beer because they got you drunk faster. Needless to say, drinking to get drunk is a good way to generate problems.

    (Now, if only I could remember where.)

  8. Sniffnoy says:

    Huh. When reading this I was like, Scott has to be straw-manning Bruce Alexander’s position, right? But clicking through to “The Myth of Drug -Induced Addiction”, it seems like indeed he’s not, or at least not much.

    Anyway, ignoring Bruce Alexander’s claims themselves, there’s something about the way he frames the issue that really bugs me. He talks about “drug-induced addiction”. But, like, generally it’s agreed, exposure to a drug is a necessary condition to become addicted to it, right? You don’t become addicted to a drug you’ve never had any of. And so in some sense all addiction is “drug-induced”, making the term useless without further specification. Well, he does seem to implicitly specify what he means, which is that he only counts addiction as “drug-induced” (or “caused by the exposure to the drug”) if it is only due to 1. exposure to the drug and 2. some sort of invisible predisposition, but not 3. more visible factors such as social ones. That seems pretty dang arbitrary to me. Why is (2) allowed but not (3)? I don’t think he’s given fitting names to the hypotheses he discusses.

    • russellsteapot42 says:

      Yeah, the hypothesis name suggests more that people with bad environments and genetic predisposition will develop an addiction to some substance or activity regardless.

  9. dawso007 says:

    Of course there is a strong genetic component to addiction at both the heritable and epigenetic level. The basic model is that about 30-40% of the population is susceptible and availability is the limiting factor. It is one thing to see heroin addiction as an inner city disease when rural folks don’t have to walk past 5 drug dealers on their way to middle school. Now that heroin use is widespread – people in rural America are addicted to heroin and dying of overdoses. Being genetically loaded for an addiction does not mean that it will happen. I have talked with many people who made a conscious decision to avoid alcohol and drugs at an early age based on their observations of how it affected their family.

    I think that it is incredibly naive to think that chronic pain patients who (on average) get a moderate amount of pain relief from opioids and use them for secondary symptoms like anxiety, sleep, and depression are less likely to develop an addiction than anyone else. The studies of these phenomenon are very uneven based on selection biases and as far as I know there are no longitudinal studies. The other reinforcer that nobody talks about is that opioids are considered magic in American culture. Even before the current 20 year opioid epidemic they were hoarded, traded among relatives, and traded among neighbors over the backyard fence. One of my friends had a knee operation and told me that he was in a recovery area with 5 other post op patients. He said they were all offered APAP, Percocet, and Dilaudid. The vote was 6-0 in favor of Dilaudid. Just another aspect of American folk pharmacology.

    With regard to whether stress and transient emotional states lead to ongoing addiction – it is less clear than it seems. Nobody discusses the consciousness aspects of addiction and they are significant. It is not a linear process and once addiction has been established it is quite conceivable that the emotional and cognitive state of addiction is produced by the same internal state that was originally perturbed as the addiction progressed. In other words, what appears to be an external trigger is really internally driven. You carry the addiction with you as much as you respond to external cues.

    • Jliw says:

      That last bit seems right to me, from my experience, if I’ve understood it correctly.

      Unrelated comment:

      The other reinforcer that nobody talks about is that opioids are considered magic in American culture. Even before the current 20 year opioid epidemic they were hoarded, traded among relatives, and traded among neighbors over the backyard fence.

      I don’t think this is superstition so much as recognition that opioids work, and work in an impressively immediate and perceptible way.

      In a life where most illnesses, aches, and pains must just be tolerated after a fractional, often questionably-existent amelioration by OTC drugs — “did it work?” “huh? oh, I guess I don’t hate the thought of moving as much as I did… I think” — the immediate and significant efficacy of opioids, in relieving the worst sorts of suffering, is instantly recognizable as extremely valuable to have access to.

      You don’t often need analgesia, but when you do… Ever seen the look on someone’s face when the pain from an infected wound suddenly fades? In that moment, I believe most would trade their cars to keep it like that.

      The other aspect you mention — the hoarding and trading — is also not so much irrational peasantry burying charms in secret stashes, I think, as it is recognition of reality once again: this time, it’s that many people have had the experience of really needing analgesia but being denied access because hysteria over the “epidemic” is predictably directed at the wrong target.*

      But that’s another rant; the salient bit is just that for your average (and non-elderly) citizen, in the U.S. and especially lately, it’s often very difficult to receive either any or adequate pain relief (depending on visibility of ailment).** Even if you had a nice cosmetic surgery and they loaded you down, you probably recognize that this opportunity is unlikely to be soon repeated.

      *, **: (E.g., my family had a hell of a time acquiring even codeine for two aging and ill people; meanwhile, my young lady friend had literally more oxycodone than she could take. Guess which party or parties have been increasingly squeezed by doctoral paranoia — so to speak — over the opioid hysteria, and which has been largely untroubled?

      The story is repeated all over chronic pain forums. There may be some selection bias here, both in my extensive personal experience and in those of the chronic pain community, but I think we can at least say this is not uncommon. Yes, invariably someone will say “hey, my personal team of physicians never balked at prescribing opioid analgesics!”, but let’s not go down that road; let us just agree that maybe both experiences are real but affected by lots of other factors.)

      • hollyluja says:

        Yes, after a stint as a tech in a retail pharmacy, Vicodin was why I decided to not become a pharmacist. The incredible tension surrounding every aspect of it meant that patients and doctors were always unhappy, and frequently taking it out on me.
        I don’t know what the answer is, but literally any other system would have to be better than the current one.

        • dawso007 says:

          I always thought that PBMs and prior authorization created the most tension between patients, pharmacists, and physicians.

          New guidelines on how to manage Vicodin should make it easier for pharmacists.

  10. Telminha says:

    Growing up in Brazil, I lived in an impoverished city and neighborhood. I remember that many of my adult neighbors were alcoholics. There was also a high incidence of domestic violence.
    The young men mostly used marijuana. I would see them in groups when I walked home from school, in front of their houses, listening to music and smoking. I felt lucky that my father neither drank or smoked.
    There was no hope for the future; only apathy and resignation on their faces. Poverty is a prison and drinking was their escape, even if only temporary.

    • jsmp says:

      I found this to be a very vivid post.

      What are the implications though. If there is no hope for the future, you can as well use drugs maybe. To quote Daniel from Freaks and Geeks: “[laughing] What? He is not gonna make it as a drummer. So why don’t you just let him have some fun, before he has to ship off.”

      • Telminha says:

        Yes. There was not much incentive to stop or not start using alcohol and drugs. “If only they had the ‘willpower,’” many used to say. “If only they could see how much their lives could improve.” I don’t think they could. I’m sure that violence fueled by alcohol would have diminished, but that didn’t seem to be much incentive for them.

        Going back years later, I noticed almost all the alcoholics died prematurely from alcohol-related diseases. Some of the teenagers and children at the time were in and out of prison; some were murdered.

        My impression was that the people who fared better were the children whose parents tried to keep them in school, even though public schools were terrible. Was it the quality of the parents more than the school itself that made the difference? I suspect so. Also, religion made some difference, I believe. There are reasonable critiques of it, but churches were a refuge in a land of hopelessness, especially for teens, children, and the rehabilitated few. They were for me back then.

        • Watchman says:

          Maybe this highlights a problem in Scott’s formulation. Happiness is possibly not so much the wrong metric to use here as not quite the right metric. What influences people towards addiction might well be a mental state, but outright happiness may not be the correct way of describing this. I can’t really find a word to describe how those who avoided addiction and acceptance from your background, and how some people I have met (including my father-in-law) have similiar problems from much less challenging backgrounds, but perhaps the best word is optimism? Being optimistic is generally a product of happy experiences, but not (from what I know) of addictive highs.

          To add another anecdotal strand to this, I went to school in an ex-mining area with high levels of deprevation by UK standards (so still good in global terms, but deprivation is a locally-defined thing). I did however go to a good school which encouraged aspiration. My peer group experimented, as teenagers are prone to do, with drink and drugs , but none of us developed addictions. We did however all have a belief we were leaving the area to go to better things (university) and whilst we might come back, we would be doing so on our terms. I didn’t realise at the time but my home area was also one of the areas with the highest rates of drug addiction in the country at the time, which helps explain how my friends got hold of drugs easily anyway. Much of the population of the area were not at a school which encouraged them to dream big, but had the same access to alchohol and drugs, and less optimism – some may have been happy (like a lot of ex-mining areas, there is surprising pockets of contentment, and unemployment was not particularly bad), but most of the population were not looking at a future where things changed for them.

          I’m not sure if this makes sense as an idea, but it might be that an optimistic/hopeful mindset gives a better resistance against falling into addiction for some reason? It seems a better construction than dealing with happiness anyway, as it does away with concerns about actual material wealth and the like. It also helps explain the role of religion (an inherently optimistic experience) in combatting addiction, and might go some way to explain how the small pleasures of things like family can match up against the highs of mind-altering substances.

          • Telminha says:

            Interesting. I read a book about resilience a few years ago. I can’t recall its title at the moment. I wanted to know what makes some people more resilient than others, and less vulnerable to PTSD and addictions. I don’t remember much of it, but the author mentions (besides a genetic component), optimism as being an important factor, not the blind or rosy variety, but a “realistic” type of optimism. He also mentions social support, religion/spirituality, and the presence of at least one good role model.

  11. Augustina says:

    Isn’t it harder to get high each time you take the drugs? Is the crash farther down? If so, that would make the experience not as desirable after you’ve been on drugs for a while. At some point it may be equal in pleasure to hanging out with your wife and cats, not taking your ethics into consideration.

    • Jliw says:

      There’s no crash from opioids — quite the opposite, in fact. You certainly do need larger doses, though, and some early experiences can end up feeling unequaled by later attempts once you’ve got a tolerance. That might be part of it (although I can’t say I ever consciously weighed it like that).

      • Mary says:

        Can need larger doses. Some people have taken opiates for years without developing tolerance by the expedient of spacing their doses, often exactly to prevent tolerance. Doing it only once a week seems to do the trick.

    • Dog says:

      This is definitely part of why I was able to quit opiates. They became much less enjoyable over time and no longer so greatly outweighed other forms of pleasure, my morals, etc. At the same time I became increasingly terrified of the withdrawals each time I went through them, which provided additional incentive to stay clean.

  12. leoboiko says:

    I’ve always wanted to smoke. The marketing and myth worked well on me, even now I find the image of it totally a e s t h e t i c, and I find the smell of tobacco smoke actually pleasant; enticing, even. Luckily, the numbers are so clear that, even with my small smattering of statistics knowledge, I took one look at them and nope’d the hell out of the idea. Didn’t try even once.

    Recently I tried 23andme and ran my results through promethease and impute.me etc., and they all basically shouted at me like “dude you’re super vulnerable to nicotine addition, and oh also to thrombosis, lung cancer etc.” I felt like I dodged a bullet (thank you, anti-smoking outreach efforts!). It will be interesting when genetic screening becomes routine in healthcare, I think.

    • Ilya Shpitser says:

      Wait, you mean you went to 23andme, and it told you you have a set of genes that makes you vulnerable to nicotine addiction, and another set of genes that makes you vulnerable to thrombosis, lung cancer, etc.?

      Hmmmmmmmm.

      Do you remember any specifics?

      • leoboiko says:

        I didn’t get the 23andme health package. Rather, I got the simple package, downloaded the raw data, and fed it to Promethease and imput.me, amont others. Promethease gave me rs1800497(C;T), rs279858(G;G) and rs4648317(T;T) associated with nicotine dependence; rs11614913(C;C), rs6983267(G;T) and rs664143(C;T) for cancer, lung included; and imputation doubled on those, and also gave some results for stuff related to DVT and activated partial thromboplastin time (which I keep meaning to test but forgot). Also, a maternal cousin recently had an unexpected, serious case of thrombosis, so it’s extra scary (the doctor attributed it to venous malformation).

  13. enye-word says:

    Ooo, do John B. Calhoun‘s rodent experiments next!

  14. Rambo Stalloney says:

    Besides genetics and individual happiness attenuation, are there significant differences in addiction rates based on cultural or religious sub-populations? For Native American + alcoholism example, I would suspect that some material part of the effect is a function of the lack of cultural practices developed alongside alcohol consumption. A more modern example that might fit this trend would be the abuse in opioid addiction in rural, white communities far in excess [citation needed] of minority, urban populations coming out of half-a-century of the drug war.

    Other historical examples I could spitball would be the ‘alcoholic’ Catholic Irish vs Protestant Englishmen, or modern Mormons vs. America at large.

    • INH5 says:

      I know that at least some of the more developed, settled Native Americans had their own cultural restrictions on alcohol. For example, in the Aztec capital of Tenochtitlan public drunkenness was outlawed, with repeat offenders sometimes even receiving the death penalty, unless you were at a festival or over the age of 70.

  15. aegist says:

    “only people in bad environments ever get addicted and addiction is entirely an environmental condition.” seems like a strawman representation of the results of the study to me. The “only” and “entirely” in particular.

    Surely the context of the original study was pushing back on the notion that it was the drugs alone which caused addiction by their mere availability. Rat Park undermined that assumption by showing that the environment can affect addiction.

    To me, Rat Park shows that there is more to the picture than mere biochemical hooks, not that environment alone determines the outcome. (Though arguably, gambling addiction already shows that the ‘biochemical hooks’ story are (at most) only a part of the story.)

  16. jobleonard says:

    The discussion as presented seems to reduce addiction a single value: “reward”.

    Surely the problem has more dimensions than that? Intuitively, many forms of pleasure that I feel cannot be directly translated into or substituted for each other.

    For example, what about that feeling that what you do is meaningful that you hint at in the last part? A feeling of living for something greater than yourself gives a very specific sense of “pleasure”, one that can actually be triggered by having to *suffer* for it. No drug that I know of is gives an equivalent feeling (not that I’m an expert).

    If you cannot translate/substitute one form of pleasure for the other so easily, could a lack of untangling these different forms of hedonism be part of what makes these studies so difficult to replicate and/or compare?

  17. Anonymous Colin says:

    “Nothing in real life is ever going to be quite as rewarding as heroin.”

    You should use this as your new blog slugline.

  18. Art Vandelay says:

    The Drug Monkey blog says that rats self-administering cocaine is the best-replicated result in drug abuse science, but also that it can be screwed up by anything from the diameter of the cocaine infusion catheter, to whether the experimenter is wearing a dirty vs. clean lab coat

    So in other words, rats becoming addicted to drugs is extremely dependent on environmental conditions.

    • Art Vandelay says:

      Just that these factors aren’t whether or not the rat has a happy life but whether or not the experimenter is wearing a clean coat.

      • rahien.din says:

        I can only see two ways that this is true, neither of which I buy :
        A. Rats have no ability to assess human cleanliness. Dirty lab coats have no effect on their happiness. Dirty lab coats still affect their rates of drug addictions through some unknown rat-psychology mechanism unrelated to happiness.
        B. Rats have the ability to assess human cleanliness, but they basically don’t care if the researchers are clean or dirty. Dirty lab coats have no effect on their happiness. Dirty lab coats still affect their rates of drug addictions through some unknown rat-psychology mechanism unrelated to happiness.

        Competing hypothesis : rats can tell if researchers are dirty, and it makes them unhappy if the researchers are dirty. Dirty lab coats make rats unhappy, which promotes their greater ability to get addicted to drugs.

        I think this is plausible. Rats are clean and observant animals, and probably they can tell who is clean and who is dirty. And dirtiness is a cue for safety because it relates to overall health, professionalism, etc. I’m not claiming that rats have some mental module whereby they judge a researcher’s professionalism. I’m only claiming that it is reasonable for a rat to conclude, instinctively, they will be better cared for if their researcher is clean. I can imagine that, if I was put in prison, I would be far more worried about my safety in the presence of a dirty or slovenly guard than with a clean and well-kempt guard.

        So I think you’ve got it wrong. I think a clean lab coat actually might make rats more happy, and this may be the link between researcher cleanliness and rates of rat drug abuse.

        • Nabil ad Dajjal says:

          What you’re missing is that lab rodents are just extremely sensitive.

          Every person I know who’s ever worked with mice, for example, has had to learn how to handle mother mice without causing them to eat their pups. If you aren’t extremely careful, and the mouse hasn’t given birth before, it’s very likely that you’re never going to see that first litter. She’ll just gobble them up.

          I can absolutely believe that something idiotic like how often you clean your lab coat could completely change how mice behave in an assay. It’s not a bad model system for a lot of neurological questions but you really have to keep in mind that mice aren’t little four-legged people. They were deeply weird animals even before dozens of generations of inbreeding.

        • Janet says:

          Correlation is not causation, and rat “happiness” is (at best) not something you can measure objectively, and (more likely) is pure anthropomorphism.

          If I had to guess, attendants who are sloppy about their personal cleanliness are also sloppy about animal care protocols as well. That could very easily disrupt legitimate results– or produce entirely spurious results. My father was a biologist, and he was always complaining about how hard it was to get graduate students to pick up on even obvious (to him) issues with the colony. As Nabil mentioned, it’s very easy to screw things up.

          In a larger sense, I don’t think we’ve got much to say about whether a rat/mouse is “happy” or not, or even whether we can speak of a rodent-equivalent to the human emotion “happy”. Physiologic states, like stress, pain or hunger, or purely/strongly instinctive behaviors, like aggression or sleep– these are probably reasonable analogues to human experiences, as they produce similar behaviors in both rodents and humans. Even there, though, you have some huge deltas– for example, what would it take to get a human mother to kill and eat her children, as is common in mice?

          But how can you speak of “happiness” for a being which has no theory of mind, no ability to reflect and abstract, consider alternatives and plan hypothetically? Humans speak of being “happy” (vs. feeling pleasure) when they are fulfilled, have achieved an important goal, are living in harmony with their beliefs, etc. “Happiness” can coexist with being tired, sore, hungry, etc. What is the rodent equivalent of being “unhappy” because you lost your job, and you’re worried about your ability to pay your mortgage (although you are currently still living at the same level of food, shelter, etc.)?

      • cuke says:

        My understanding from other studies done on rats and stress is that the dirty lab coat is stressful because it holds more of the lab technician’s testosterone and testosterone is stress-inducing for mammals.

  19. Jack V says:

    “Dynasty that slaughtered most people in Asia has drinking problem, news at 11!” OK, not really, your summary is persuasive, but I feel like “responsibility for lots of stuff including life and death of lots of people” is probably something that does fall on the “bad” side of the “are you likely to get addicted” bandwagon, even if “not enough to eat” is too.

    • Jack V says:

      And I know we covered this already, but oh my god society is so depressing.

      Medicine: Oh, hey, would you like this drug that has no major side effects and cures heroine addiction?
      Society: No.

      • cuke says:

        I’ve found it frustrating working with parents of people addicted to heroin how much shame and resistance people feel around doing medical management of addiction (methadone, etc) — here in the U.S. I gather it’s better most other places.

        Families are willing to spend thousands of dollars on residential rehab programs that are abstinence only — and that includes people having to come off of their antidepressants because some facilities “don’t believe” in pharmacological solutions. So kids going off of opiates, who have underlying other mental illnesses, have to also withdraw from SSRIs and other meds. But those same kids and families consider a methadone program to be “failure” even after four or five relapses and costly stints at residential rehab.

        It’s like the evidence on this counts for nothing. The culture around abstinence recovery programs (or whatever we call them) is powerful in some regions. Very frustrating. I think it’s fine people have that option if they want it, but I also feel like there should be truth in advertising about their efficacy up against medical management, partly too because insurance companies and families are spending tons of money on those programs without their having to report outcomes.

    • Worley says:

      Well, responsibility is not fun unless you have the right sort of personality. But power, where you get to do what you feel like and nobody can tell you they don’t like it, is reputed to be a lot more fun.

  20. JoshP says:

    Again I apologize if it has been said before (and I guess it has, because the idea is obvious).

    Take the same rats who dud so well in the “park” to a kind of “getho” and see how they, and their decedents fare in regard to drug dependence.

  21. rahien.din says:

    I live and work in Appalachia, where there is a stunningly high degree of opiate abuse.

    One important feature of my patient population is fatalism. People believe that they have little-to-no control over the outcome of their lives, which are going to end up grinding, enervated, and shortened. They’re all just waiting to die. In that circumstance, immediate rewards drastically outweigh future consequences because the only chance you have at feeling good is to do it now before the world takes it from you. In the kids, that manifests as high-risk behaviors and lowered graduation rates, and in the adults, one prominent outcome is opiate abuse.

    This is not to claim that life wouldn’t otherwise suck for them, and neither do I blame them for all their troubles. At baseline, it’s hard, hard living for a lot of these folks.

    • Eponymous says:

      I think fatalism is a really common mentality among relatively poor people, especially those living in impoverished rural areas. My dad’s family is fairly poor, and his mother came from a *really* poor rural family, and my mother always said they were very fatalistic. Like if a kid was struggling in school (e.g. my uncle who probably has a learning disability), they would just shrug their shoulders and say, “Well, what can you do?” Not try to think up a solution.

      This is interesting to me, because my dad’s family would probably grade out as having a fairly high IQ; so it seems that their fatalism is a large source of their continued poverty. I’m not sure how much of the fatalism is genetic vs. cultural. Even in Appalachia, maybe all the people with the “get up and try to improve your lot in life rather than stick it out” gene left 20 years ago.

      (Random side note: I also have a theory that many of the cultural differences between the U.S. and Europe are because the 30% of the population with the “get up and try to improve their lives” gene emigrated to America.)

      • rahien.din says:

        I’d be wary of any overt claim that :
        A. the poor lack the drive or desire to “get up and improve your lives”
        B. to the extent that A is true, that it is an outcome of their genetic constitution

        It’s just as easy to construct a narrative that the people who didn’t emigrate are the ones who are genetically predisposed to fixing problems instead of fleeing from them.

      • Squirrel of Doom says:

        I have thought of the same theory.

        Any ideas how to test it empirically?

        • hollyluja says:

          I can’t find it right now, but I read a study one time that claimed that the further your people are from the cradle of civilization, the higher the rate of ADHD in the population.

          That would mean the rates of ADHD should be highest in…. Argentina maybe?

          And indeed South American does have the highest prevalence, and the Middle East the lowest.

      • anonymousskimmer says:

        Following the immigration discussion picked up by rahien.din and baconbacon, it’s important to observe that immigration happens in different socio-economic stages.

        Early on you’re moving with few others to literally start something new where there are fewer people (at least of your kind). Later comers migrate after communities have built up. Others after their own kin have settled. Others because their vocation is in short supply and thus highly compensated. Some come from relatively stable communities, others from less stable or even persecutory communities. Some immigration is involuntary, or starts out involuntary and then becomes voluntary (e.g. conscripts who decide to muster out in the new land, adopted children). And there are always those who cannot immigrate, even though they want to.

        All of this immigration happens over the course of centuries, for very different reasons.

  22. Winter Shaker says:

    We don’t know the exact size of Ogedei’s harem, but his father Genghis kept about three thousand concubines, and his successor Kublai had seven thousand, so if this kind of thing increases linearly, we can estimate Ogedei had somewhere around 5,000

    Okay, this is off-topic, but assuming these figures are in the right ballpark … wtf? How can you even get through that many sexual partners? I mean, if you’re an absolute ruler who’s into having as many partners as possible, I can understand wanting to keep as many women as you can physically mate with, but unless the Khans (and the other kings mentioned in the linked article) had superhuman rates of semen production and superhuman memory, you’d have forgotten that you’d already slept with any given concubine long before you were scheduled with her again, and even then, you’d presumably have little time left for conquering or governing your empire.

    Okay, I guess there’s an element of ‘showing off how many women you have to choose from’ rather than actually sleeping with them all, but still, it seems a bit wasteful.

    • BlindKungFuMaster says:

      I think that a) women are not kicked out of the harem once they are older and b) harems are inherited. So these thousands of women span several generations.

      That being said, there is this finding that some 16 million men today carry some genetic marker that can probably be traced back to Genghis Khan.

      https://en.wikipedia.org/wiki/Descent_from_Genghis_Khan#DNA_evidence

    • vV_Vv says:

      Okay, I guess there’s an element of ‘showing off how many women you have to choose from’ rather than actually sleeping with them all, but still, it seems a bit wasteful.

      Jeff Bezos net worth is estimated at $ 82.9 billion. What does he need all this money for, other than showing off? Isn’t it wasteful that this amount of resources is under the control of a single person? Probably yes, but this is how social hierarchies work.

      • Eponymous says:

        Why is it wasteful? Isn’t someone capable of making that amount of money more likely to use those resources wisely?

      • Winter Shaker says:

        Yes, if he’s just sitting on a pile of cash, that is indeed also wasteful. But he could presumably do more fun and/or useful stuff with that cash than he could do with a pile of more women than he could possibly sleep with.

        But maybe I am actually badly underestimating the virility of these harem-keeping kings. Does anyone actually have any data on how many women per day Ögedei Khan was having his way with?

        • Nabil ad Dajjal says:

          No real data but some anecdata:

          When you’re single and have two or more FWBs it’s pretty easy to have sex with one girl a few times in one night, wake up for another round or two, then go home and invite the other girl over to repeat the process that night. If you distributed that total frequency of sex acts over a larger number of women that could get you over 1,000 per year.

          That said, I don’t know how sustainable that pace is for more than a few days in a row. It’s possible that after a month it would just shrivel up and fall off.

          • The Nybbler says:

            According to Marco Polo, that’s what the Great Khan did — six new girls every three nights. That doesn’t quite get you to 1000, but maybe he fit in a few extras when there weren’t visiting Italians to entertain.

          • baconbacon says:

            If I had to guess you probably are upping your visual sexual prowess for visiting dignitaries, not cutting back.

        • baconbacon says:

          Even if they aren’t sleeping with them all they are being used in other ways, unless you imagine that 5,000 women are perfectly chaste when not having sex with the Khan.

        • Nornagest says:

          At some point, I imagine the size of your harem has more to do with keeping up appearances for the other kings than actually having sex with your haremettes.

    • Besserwisser says:

      It should be noted that rulers did tend to catalogue the number and activities of their wives. There’s at least one document about the process of how Ramses the Great chose his wives and it tells us in detail about his sexual preferences.

    • Mary says:

      Memory? that’s what you have eunuchs for. They will carefully record every visit because if she becomes pregnant, it’s crucial to keep track of these things.

      At least in some times in China it was deemed crucial for the emperor to have a large selection so as to have something to appeal at any given time, to make sure they had that heir.

    • Ketil says:

      Yeah, I don’t think it was this large for any practical reason, more as a symbol of status and wealth. The Great Khan has x thousand warriors, y thousand cows, and z thousand wives, something like that. I also suspect tribute might be paid in gold, livestock, and a selection of young women.

      An (alleged) excerpt from Marco Polo describes how Kublai now and then would receive a few hundred women from a tribe of particular beauty, and after begin trialled by some older ladies in the harem, would be sent in to attend the Khan six at a time. https://my.ilstu.edu/~rkenned/China/Khan_Consorts.doc

  23. Speaker To Animals says:

    Unless you are a utility monster increased wealth is unlikely to bring a proportionally higher lever of happiness. Sure, it’s great to be rich but people associate happiness with improving prospects. Give me $100 it might make a significant difference to my day but if you are a billionaire $100 dollars isn’t worth chasing after if it blows out of your hand.

    A lot of drug users are chasing after that first experience of using the drug. It’s not just that they build up a tolerable to it, it’s just that a future high is unlikely to be a quantum leap over previous experience.

  24. Fossegrimen says:

    If happiness is largely genetic we seem to have an explanation that fits all the observations?

  25. alwhite says:

    So, obvious consideration here. Ruling an empire doesn’t make one happy and number of concubines doesn’t correlate with happiness. An argument based on Ogedei Khan being the happiest person is a pretty flawed argument. The listed evidence for Ogedei being “really happy” is pretty scant and easily falls into the myths of history category.

    Here’s a study saying each ACE increases the risk of drug abuse by 2-4 fold.

    Here’s a study saying things like “83% of women with a substance abuse disorder report neglect in childhood”, “Lifetime alcoholism among neglected adults is 40% compared to 13.8%”

    Here’s an article of a physician who treats a lot of substance abuse.

    And another study of alcohol
    and substance abuse following PTSD in Vietnam vets (small sample).

    This could go on for quite a while. I don’t have the book with me, but the APA [The American Psychiatric Publishing Textbook of Substance Abuse Treatment, if you’re curious] has listed only two substances as biologically addictive: alcohol and barbituates. All the other drugs are considered psychologically addictive. Again, I don’t have the book on me and I might be mis-stating this, but it seems like an important thing to consider.

    I think there’s a very strong argument for environment affecting drug use and addiction. The research on trauma is growing and changing how we view symptoms.

    • Bellum Gallicum says:

      The APA suggests that nicotine and opiates are non physically addictive? That’s seems like a caricature of their idiocy.

      • alwhite says:

        I think I have this confused with withdrawal symptoms. Alcohol and Benzodiazepines are the only drugs that have dangerous withdrawals. All other drugs do not. This turns into a conversation about dependency, so alcohol and benzos change your body and make you chemically dependent on them in ways that other drugs do not.

        How does this inform addiction? Things like nicotine create cravings but your body isn’t dependent on nicotine. It’s just an unpleasant experience. This becomes a definitional exercise, what defines an addiction? There isn’t a clear answer and we need to be careful about what we’re talking about.

        I would conclude that opiates and nicotine are not addictive in the same way that alcohol and benzos are.

        • notpeerreviewed says:

          Alcohol and benzos are the only ones where the withdrawal can literally kill you all by itself. That doesn’t mean other drugs don’t change your body and create dependence, as anyone who has gone through opiate withdrawal can tell you.

        • Nornagest says:

          From what I’ve heard, nicotine’s mechanism of addiction is rather unusual. Most addictive drugs are addictive because of their euphoric effects: you take a hit or do a line, and your biochemistry takes that as a reward signal. Hey, this is awesome, let’s do it some more. Nicotine’s only about as strong a euphoriant as other weak stimulants like coffee, though. Instead it works on the reward system directly, creating the “let’s do this some more” effect for whatever you’re doing — which is usually “smoking” — without an intermediate “this is awesome” step.

          I’ve occasionally wondered whether it’d be possible to use nicotine patches or something like that to habituate myself to other stuff. Seems like playing with fire, though.

    • Eponymous says:

      I’m quite concerned about causality in these studies. Childhood trauma, abuse, and neglect are probably correlated with all kinds of other environmental and genetic factors that might make substance abuse more likely.

      • alwhite says:

        Is there more to say on that? Are you saying cancer causes substance abuse vs cancer causes death of parent causes substance abuse?

        It’s not odd to show that parents with substance abuse cause children with substance abuse. That seems kind of obvious, but there’s more evidence than that. The PTSD/Vet study showed that substance use originated post trauma and increased as symptoms increased.

    • greencerenkov says:

      Playing devil’s advocate on the ACE thing: a lot of childhood trauma might be based in a parent’s addiction, so it’s hard to disentangle whether your parent was an abusive alcoholic and now you self medicate your CPTSD, vs your parent was an abusive alcoholic and also gave you a gene for alcoholism.

      • alwhite says:

        The Dunn et al study references hundreds of studies trying to tease that distinction out. There are other findings showing that addicted parents display behaviors of neglect. Neglected children without substance abuse in the home still have higher substance abuse rates.

        And again, genetics can only account for 50% of the risk and risk is not guarantee. You can not become addicted without consumption so something motivates the initial patterns that allow a gene to have influence.

        • greencerenkov says:

          I mean, just about everybody at least is exposed to alcohol, and it seems like the vast majority of adults drink alcohol at least sometimes. Going out of your way to try a drug that’s socially stigmatized, yeah, i could see that being an ACE thing. But I don’t think that’s an explanation in areas where there’s widespread acceptance of casual substance use.

  26. Besserwisser says:

    Imagine someone engaged in a scummy job they feel bad about doing, like spammer or tobacco advertiser or bioethicist. They want to quit, but they get a really good salary – let’s say $100,000/year – and they’re not sure they can do without the money. If they’ve got another wholesome option that pays $50,000, maybe their conscience is strong enough to help them make the leap. If their only other option pays $15,000, that’s going to be a lot harder.

    It’s funny, this is more or less what I considered regarding my career. A coding job in the US can easily earn you $100,000/year. It’s about half where I live. And I’m assuming work in the US is going to be more miserable in terms of working hours and vacation.

  27. snifit says:

    I laughed, but the joke about bioethics is the sort of thing that could be used against you in the future.

  28. baconbacon says:

    Others have pushed back on the idyllic nature of celebrity, I want to do so for Native Americans. Just because you weren’t living in direct contact with white settlers doesn’t mean your lifestyle wasn’t influenced by them. Most accounts I have read have the majority of deaths attributed to European settlement coming from diseases that spread to them before contact with settlers. This would have been transmission across native tribes, and importantly I have never seen claims of steady repopulation, despite an abundance of resources, ample land and a good set up for high fertility rates. This probably means that the diseases continually re swept through their populations, and probably means that childhood mortality was extremely high. Work outdoors, be physically healthy and commune with nature doesn’t sound as great if there is a 2-3% chance every year that you will lose multiple children, nieces, nephews and cousins to demon pathogens. Even if your tribe was spared you would periodically come across the remains of others that weren’t, and the outcast, haunted survivors who fled.

  29. moridinamael says:

    Does Suboxone cause any significant behavior change aside from curing opiate addiction? I would be surprised if it didn’t. I would think it’s gotta muck with your reward circuitry in some noticeable way if it can change your relationship with opioids that quickly.

    • Dog says:

      Suboxone is itself an opioid. This is not to argue against it, but to say it cures opiate addiction is not really accurate. It maintains the addiction, but eliminates many of the negative consequences associated with black market drugs. It may also have an advantage as a long acting, strongly binding partial agonist, in that it sort of holds people at a lower level of addiction then they would otherwise be at, while blocking the effects of heroin and other shorter acting drugs that tend to cause more obsessive behavioral cycles.

  30. Bellum Gallicum says:

    Happiness is one way of looking at it but I think perspective is even more importance. When I talk to addicts about smoking drugs or food what often comes up is a feeling of not being in control. That their life is up to forces outside of themselves.

    I have learned from addicts to call this the external locus of control. Once people are operating from this perspective it’s hard to self regulate and easy to tip into compulsive behavior. Which behavior we choose to get addicted to I think stems from our genes and cultural availability

  31. ParryHotter says:

    I find it surprising that someone as insightful and observant as Scott would accept the premise that possessing wealth/power/fame = happiness.

    Scott, don’t you remember what Hillel taught us in Pirkei Avos (Ethics of the Fathers)?

    “The more possessions one has, the more worries he has.” (Chapter 2, Mishna 7)

  32. Nate the Albatross says:

    The problem with nature vs nurture debates is that both can find some positive correlations and leap to completely irresponsible conclusions. Yes, genetics is super important. But people get scurvy and die if they don’t eat any vegetables so clearly environment matters.

    When we look at celebrities in particular, the argument that if only we would just institute a guaranteed national income and allow everyone to pursue art or their dreams then drugs would disappear looks bizarre. Clearly there are plenty of people who are wildly successful who still become addicted to drugs. Cocaine is a powerful drug, and “””willpower””” or a nice house in the suburbs are probably not adequate protection.

    However, I do think there is an argument that without after school sports and gainful employment drug use becomes worse. The Onion had a joke “drugs now legal if the user is employed.” Odegai Khan had well meaning advisers and friends who tried to help him. And while he only lived to 55, plenty of poor people die much sooner. I wish Carrie Fisher had lived to 100, but I’m also grateful she didn’t die in 1983.

    Ultimately I agree with Scott’s conclusion: fight on both fronts. Officials should work to improve poor people’s lives through economic and social policies – I hear there are benefits to that aside from decreased drug use – and the medical community should look into anti-addiction drugs that can be added to the drinking water supply.

  33. Saint Fiasco says:

    Are we certain that happy people don’t abuse drugs? When a happy person is caught (ab)using cocaine, it is in their best interest to act like they are miserable and just couldn’t help themselves. TLP wrote about that in one of his great digressions on semiotics.

    The obvious example of this sleight of hand is that there’s alcohol use and alcohol abuse, but there’s no such category as cocaine use, even though the vast majority of its ingestion has nothing to do with addiction. The reinforcement is from the outside to comply with this idiocy: say you party down one weekend, then a random drug test at work, oops! So two things can happen, Guess What Happens Next: you could tell the truth that the coke was on her ass and how could you not? doesn’t make you a bad person; or pretend/admit you’re an addict and agree to go to rehab. So it’s unanimous? You keep your job at McDonalds and the system gets another data point confirming it is right.

    From https://thelastpsychiatrist.com/2012/06/amy_schumer_offers_you_a_look.html

    • greencerenkov says:

      Isn’t the whole point there that there are casual coke users in the same way their are social drinkers? So people who are NOT abusers are incentivized to claim that they are, because coke is just that stigmatized.

      • Saint Fiasco says:

        That is what TLP proposes, but I was thinking that happy people who abuse may pretend that their life was (before the drugs) more miserable than it really was, to protect their self-image.

    • cuke says:

      For whatever value the DSM 5 has (and that’s debatable), the criteria for substance use disorder includes things like using more of the substance than one intended and wanting to cut down or quit and not being able to, as well as the use impairing one’s ability to fulfill major obligations at home, school, or work.

      So someone who is happily using whatever substance they use and it’s not a problem for them and it’s not getting in the way of their life in a major way wouldn’t be considered as having a “disorder.”

      Sometimes a person’s use is a problem for someone else — an employer, a parent, a partner — even when the user is fine about where they are. And that’s about social stigma or fear or shame or whatever. So one thing I like about the DSM diagnosis is that it keeps at the center the person’s own experience.

  34. greencerenkov says:

    Imagine someone engaged in a scummy job they feel bad about doing, like spammer or tobacco advertiser or bioethicist. They want to quit, but they get a really good salary – let’s say $100,000/year – and they’re not sure they can do without the money. If they’ve got another wholesome option that pays $50,000, maybe their conscience is strong enough to help them make the leap. If their only other option pays $15,000, that’s going to be a lot harder.

    On the topic of rational tradeoffs: I wonder if any of y’all have opinions about Carl Hart’s work? He’s done experiments in which he administers varying doses of crack cocaine, and then gives them the option to take additional doses, or to be given cash in a few weeks. When the initial dose of crack is fairly low, most of the addicts still opted to receive cash in a few weeks rather than receive another hit now. So even if Rat Park per se won’t replicate, it seems like there’s a certain element of rationality–bounded rationality, to be fair–in some decisions involving drugs, even when addiction comes into play.

    My suspicion is that having salient alternatives to getting high is still a big factor. Other commenters on here have mentioned external locus of control as a big factor in the addiction they’ve seen, and I think that’s spot on. It also seems plausible that that’s the factor that unites both homeless addicts and celebrity addicts, what with celebrities’ status being dependent on public whim. There’s a stereotype that former child actors are particularly prone to drug abuse, and that would also fit with the external locus of control model, given the sort of manipulation and abuse that a lot of child stars experience. Of course, I’m not sure if former child stars are more likely to become addicts, or if that’s just a popular media narrative (like the 27 Club)

  35. Sniffnoy says:

    You know, I just realized, this whole post is talking about to what extent genes influence drug addiction, and to what extent happiness does… but let’s not forget that there’s also the whole “happiness set point” idea. It’s possible that you may also get a contribution to drug addiction from happiness which is in turn influenced by genes.

  36. carvenvisage says:

    Ogedei Khan had to be in the top ten. The son of Genghis Khan, he took over his father’s empire and continued the family tradition of conquering things. China, Korea, and Eastern Europe all fell to his armies; for over a decade he conquered and conquered without suffering a single serious defeat.

    The metric seems totally sideways. Who do you think was happier, stalin or the buddha? I mean, I can see why having tens of thousands of people killed might make you want to drink.

    (as for the german soldiers, perhaps they generally didn’t consider themselves responsible in the same way)

    Same goes for the celebrity lifestyle. Highest up person doesn’t = happiest person.

    If you have a crappy life that doesn’t have any other source of reward at all, then all the “““willpower””” in the world won’t save you.

    Well, ‘all the willpower in the world’ is the sort of willpower that *starts* around ‘climbing everest’, seeing as a lot of people have done that, so I suspect you’re using the phrase in its colloquial sense of ‘the kind of willpower it takes to not eat a sweet’, and the literal meaning seems a good deal more relevant to the case in question -of drug addicts with nothing but willpower to go on.

     

    edit: every other comment makes my first point lol. We are paying attention!

    • TheEternallyPerplexed says:

      as for the german soldiers, perhaps they generally didn’t consider themselves responsible in the same way

      Adverse childhood events may also have been playing a role, and they may have been on average far less able to understand the nature of what they did/witnessed/knew in a way we do today.
      Prescott researched the role of education and “concluded that the disrupted child-mother bonding process was an absolute predictor of the emergence of violence, hierarchy, rigid gender roles, a dominatory psychology and violent territorial acquisition.” (same wikipedia page)

    • Jiro says:

      Who do you think was happier, stalin or the buddha? I mean, I can see why having tens of thousands of people killed might make you want to drink.

      Probably Stalin is happier.

      You need to avoid typical mind fallacy (killing lots of people would weigh on my mind, so it would on Stalin’s) and just world fallacy (killing is evil, so it must affect Stalin himself negatively).

    • dndnrsn says:

      There’s many anecdotes about Stalin not drinking a lot, at least by the standards of a Russian guy of his time. He was, however, notorious for encouraging those around him to get drunk, more than he was, so as to be the most in control of his faculties of those present.

  37. Ttar says:

    Imagine someone engaged in a scummy job they feel bad about doing, like spammer or tobacco advertiser or bioethicist

    .

    shots fired

  38. Douglas Knight says:

    What is the 5 year survival rate of Dr Drew’s TV rehab? It sounds really bad.

    And what is the base rate, the 5 year survival rate of celebrities publicly known to have gone into drug rehab?

  39. BeatriceBernardo says:

    But if having a happy family and doing meaningful work and so on are, I don’t know, a quarter as rewarding as heroin, then maybe you have an opportunity to use “““willpower””” to force yourself the rest of the way and take the only-a-quarter-as-rewarding option.

    I can’t see the difference between that and

    And Rat Park tells us what those variables are: the social factors that make the difference between a terrible life and a flourishing one.

    Except that you added “any reward” instead of just “social factors”

    But more importantly, I would really like to challenge your definition of flourishing. That hunting and gathering Indians, Khans, celebrities and rich people are not “flourishing”. I know that it is not fair to keep on moving the goal post, and I don’t know where should that goal post be yet, I just have a hunch that hunting and gathering Indians, Khans, celebrities and rich people are not good proxy for “flourishing”. To be fair, if I absolutely have to take a stab at defining “flourishing”, it would be… William’s syndrome? My confidence level is really low, but I hope I’m getting my point across, sorry for my poor communication.

  40. yodelyak says:

    With regard to

    But remember: society is fixed, biology is mutable.

    I think the correct rejoinder is: “Stay away from easy.”

    Also, can anyone help me find the original place where Scott reportedly said this: “All good is hard. All evil is easy. Dying, losing, cheating, and mediocrity is easy. Stay away from easy.” Can’t seem to find it now, except at places like BrainyQuote that are wrong more often than right…

    • Douglas Knight says:

      here.

      Have you ever wondered what Scott looks like?

      • Nornagest says:

        Different Scott Alexander, I think.

        • Protagoras says:

          Yeah, that seems to be somebody actually named Scott Alexander, rather than our host who uses that as a pen name. Since I have met our host in person, I can also say this guy doesn’t look much like him.

          • yodelyak says:

            Hmm.

            Needless to say, I’m embarrassed at my mix-up. Rather than using our host’s own words to challenge his point, I’ve made a hopeless non sequitur. Thanks Protagoras and Nornagest and Douglas Knight for shedding some light.

            I guess my general intuition remains that the seeming easiness of availing ourselves of biological mutability should be a warning, not an invitation. The intuition was independent of my thinking I had the perfect rhetorical flourish with which to make my point, so I guess I stand by what I had intended to say about treating biological mutability as a route around society being “fixed”.

            So, this time in my own words, I think biological mutability looks like an easy road only if you’re using the kind of mindset of, for example, a high schooler who cheats their way out of having to learn very much, or develop much discipline… what looks like a short-cut can also be a failure to grasp the extent of the distance that must–must!–be traveled. We need to have consistent principles that govern any action taken in the “biological mutability” space, which means some kind of societal change enshrining said consistent principles comes *first,* or consequences could be, uh, dire. That makes biological mutability look like what it is… something coming terrifyingly soon, for which we are almost certainly not going to be ready.

  41. Sermeapes says:

    You’re going a little bit off track at the part on willpower vs addiction-behavior. If there is nothing as rewarding as using heroin then we would literally have no reason not to use heroin all day long. The problem is in addiction is not that we think the substance has the highest reward and that therefore we use it. If that were the case then become a drug addict would actually be in our best interest. The reason most of us not is that other things are actually more rewarding, but the time-delay to getting the reward is where it actually gets tricky. Rewards that are more delayed are discounted i.e. Would you rather have a coockie now or in 1 year?

    The interesting part is what we actually mean when we say ‘willpower’. In this view, ‘willpower’ means something like the ability to ignore the time-delay when choosing, or rather, to discount at a lower rate. The more willpower one has, the less discounted future rewards will be, and the easier it is to study at night (large future carreer-reward) instead of going drinking (small immediate reward). An interesting read on this is breakdown of will by George Ainslie.

  42. Steve Sailer says:

    Hollywood movies tended to be anti-alcohol Prohibition but pro-cocaine prohibition. Jewish and Italian screenwriters and directors didn’t have that much trouble with alcohol in the 1920s-30s, but lots of trouble with cocaine in c. 1975-1985.

  43. MB says:

    I’d also be curious about epigenetic factors, whether a certain lifestyle can make one more or less predisposed to or prime one for addiction.

  44. anonymousskimmer says:

    I know it’s not pertinent to the central point you are making, but I will beat this horse to eternity:

    And Rat Park tells us what those variables are: the social factors that make the difference between a terrible life and a flourishing one

    Rat park changed the typical social, sexual, environmental (i.e. spatial and material surroundings), and due to the sheer size of Rat Park versus the cages, and the fact that humans would be refilling the food and water containers, rat-human interaction (xenosocial?) factors. Not just the social factors.

    But does environment affect addiction at all?

    Thank you.

    Society and genetics have to interact somehow

    society is fixed, biology is mutable.

    The external world and genetics have to interact somehow.

    The external world is fixed, biology is mutable.

    Otherwise very interesting post. I hope that some of those in power vis-a-vis addiction are paying attention.

  45. Worley says:

    One amusing aspect of this, when examining the people who push Rat Park-type results, is that there clearly is a strong social component to becoming addicted: If you can’t get access to the substance without a lot of work, then you’re unlikely to get addicted to it, regardless of your propensity to that addiction, because you’re unlikely to try it. But the people who say “social forces cause addiction” don’t want to mention this most powerful of social forces causing addiction.

    It’s not clear to me why, though. There does seem to be a strain of liberal thought since at least the 1970s that wants to attribute all “bad” behaviors to cultural factors, but only to a certain sort of cultural factors… generally, if people around you act in ways that make you feel bad. But if everybody around you loves you, then you will automagically behave well toward everybody else (including avoiding inconvenient addictions). This seems to correlate with the popular version of the Dr. Spock theory of child-rearing, which seems to come down to “If you love your child intensely enough, then your child will desire to please you.” Many millions of mothers have been made frustrated and unhappy by that advice. (But I’m sure I only see the vague outlines of this phenomenon.)

  46. googolplexbyte says:

    I’d have thought running the largest land empire of its time would be a very stressful job.

    The kind of stress that would drive someone to drink.

    A good example would be to compare opiate addiction in doctor vs, patients, since the doctors would have higher stress levels and opiate access.

  47. Nancy Lebovitz says:

    >When the khan met important visitors he sat at a great throne with one staircase for ascending and another for descending.

    He obviously needed one more leading nowhere just for show.

  48. Nancy Lebovitz says:

    Hypothesis: addiction is related to high sensitivity to dukkha.

    I’ve seen the idea that people who are uncomfortable in their skins– life feels bad all the time– are vulnerable to addiction.

    A lot of people, maybe a large majority, can’t even notice that nothing is quite satisfying without a lot of meditation.

    It’s plausible that ACEs prevent people from feeling good.

    Suppose that there’s some combination of a lot of pain and/or lack of insulation against pain which lead to addiction. So, unfortunate genes and/or bad circumstances increase the odds.

    As for movie stars, I’m willing to take that as an example of civilizational incompetence, where the best rewards the civilization offers to people who are highly valued makes those people miserable, and yet people keep seeking those rewards. It’s like having popular music that makes people deaf.

    • anonymousskimmer says:

      I’m willing to take that as an example of civilizational incompetence, where the best rewards the civilization offers to people who are highly valued makes those people miserable, and yet people keep seeking those rewards.

      I don’t know if it’s physiologically possible for humans to adapt to a social sphere that is so fricking large and immediate. Wanting everyone to know who you are and to value you in a particular way has very different repercussions if you’re limited to a community of hundreds or thousands versus hundreds of millions. Even the roving bards and knights (i.e. sports heroes) of yesteryear didn’t have everyone they passed knowing who they were and approaching them.

      • Nancy Lebovitz says:

        It probably could work out differently if there was a consensus that it was bad manners to just walk up to celebrities and start talking with them.

        And worse manners to snoop into celebrities’ private lives.

        • anonymousskimmer says:

          Oh yeah.

          But it ain’t going to happen. Trying to affiliate with the famous or powerful (or merely skilled) is a powerful motivation.

          I honestly think that we’d need draconian laws to create such a consensus.

  49. Floccina says:

    People that I know who used drugs did it for excitement and amusement out of boredom. So when I heard about that study, I objected, the rats where put in a very boring environment but the Ghetto is no more boring (probably less) than the suburbs and a lot of poor people do not worry about anything and that’s why they are poor. If you are a low earner and worry about how yo will live when you get too old to work you live like this guy:http://earlyretirementextreme.com/how-i-live-on-7000-per-year.html
    BTW the poorest county in the USA is not high in drug use: http://www.nytimes.com/2011/04/21/nyregion/kiryas-joel-a-village-with-the-numbers-not-the-image-of-the-poorest-place.html
    But one of our richest lowest unemployment states is no.2 in opioid ODs: https://www.usnews.com/news/best-states/articles/2017-06-28/why-new-hampshire-has-one-of-the-highest-rates-of-opioid-related-deaths

Leave a Reply