Democracy’s Drawbacks

 

There have always been a few drug addicts around, but this is different. The opioid epidemic has gone from a theoretical issue to a national crisis seemingly overnight, and it continues to grow like wildfire. Like most social problems, it can be difficult to find a solution, so it’s easier to just try to find someone to blame. Unfortunately, punishing the perpetrator is tricky when the victim and the perpetrator are the same person. One problem with liberty and self-responsibility is that it becomes more difficult to find someone to blame for your troubles. But every story needs a bad guy. And in politically correct American media, that bad guy can’t be a poor person, and it can’t be government. It has to be either a conservative or a corporation. You would think that simply following the playbook to a forgone conclusion would simplify investigative reporting, but in fact it can make it much more complex. What if that forgone conclusion is either questionable or outright ridiculous? That leads to some very creatively written news stories.

So I get my latest issue of JAMA (Journal of the American Medical Association), and front and center in this issue is an article called, “Lessons Learned from the Opioid Epidemic.” The first sentence of this article reads thusly (emphasis mine): “Oklahoma’s recent settlements with Purdue Pharma and Teva Pharmaceuticals, and the trial in the state’s lawsuit against Johnson & Johnson, signal that the opioid epidemic is entering a new era of accountability.” So to the authors of this article, their idea of accountability is to blame those who made the drugs. NOT those who took the drugs, and certainly not those who bought the drugs (very often, government – many of these people receive various forms of government benefits).

One wonders if these insightful physicians will attempt to cure obesity by suing corporations which make spoons.

To be clear, the pharmaceutical companies are accused not just of producing opioid drugs, but also of stating that their drugs were safer and more effective than they really were. But first of all, every company that produces anything is likely to see their own products in a positive way.

But that’s not the point. As a physician, I just don’t understand this lawsuit. We all know how addictive and dangerous these drugs are. We rarely used them until everybody from 60 Minutes to the CDC started screaming that people were suffering needlessly because heartless physicians were ignoring their pain, while withholding treatments that would reduce their suffering immediately. Then we had pain, the fifth vital sign. Rate your pain from 1 to 10. We were told that we were not treating pain aggressively enough, and you can understand that point of view. And presto, over-prescribing became a problem.

But it’s a relatively small part of the problem, in my view. Some people get prescriptions from physicians, but many people get their opioids via other means.

Lots and lots and lots of people really want these drugs all of a sudden. Something has changed, beyond the prescribing habits of some physicians. I don’t know what it is.

People now expect to be pain free? People are less willing to accept the difficulties of life and want a pill to make it go away? People are not as tough as they once were? People are unhappy or stressed out and like drugs that dull their anxiety etc? The 60’s taught people that there are better drugs available than booze? People have lost hope for the future and just want to feel good today? Marijuana distribution networks make it easier to get opioids into typical communities? I could guess and guess and guess – I really don’t know what has changed. But something has changed. Something really, really big.

And what strikes me as remarkable is that Americans in general, and this article in particular, seem to have little interest in what that big thing is.

In the remainder of the article, they blame doctors, pharmaceutical companies again, lack of education, and pharmaceutical companies yet again. But they never mention those who took the drugs or those who bought the drugs.

Comparing drug addiction to alcoholism is a dangerous business, but just think about it on a small scale. First of all, a drunk probably buys his own booze. He is likely to be encouraged to quit by those who love him the most. So his wife will tell him, “Stop buying booze.” This may or may not help, but she views that as a big part of the problem. If his friend is buying booze for him, she will ask the friend to stop buying booze for her husband.

Again, she’s trying to help, and will likely focus on the problem of her husband buying too much alcohol and drinking too much alcohol.

She is unlikely to blame Jim Beam. And if she does, she will never be able to help her husband. And her husband will be unable to help himself, as long as he insists on blaming others for his problems.

So what do we do in this “new era of accountability in the opioid epidemic?” We blame pharmaceutical corporations. Swell.

I hesitate to even post this, because I don’t want to hear about how Oxycontin 40mg QID really helps your fibromyalgia. And I’m uninterested in the inevitable scathing comments which will suggest that pharmaceutical companies have an interest in profits. Ok, fine. But that’s not at all what I’m writing about.

I just think that intentionally ignoring the root causes of a problem – any problem – will tend to prevent us from solving it. Ever. We have to develop, at the very least, an interest in why something is happening. We should try to find the cause, even if we don’t want to hear it. It’s ok to look for a bad guy, as long as you’re willing to accept that the bad guy may be you. Or worse yet, someone that you care about.

I think that one reason that so many social problems go unsolved is not that we can’t find the solution. It’s that we don’t want to find the solution. It may be uncomfortable. It may challenge our beliefs or sympathies. It may be right, but we don’t want to hear it. Understandably. Who wants to deal with uncomfortable realities? Surely there’s another way, right?

But by averting our gaze, we discretely abandon all hope of reducing the suffering of millions, while we publicly sympathize with their plight.

These problems are difficult. The solution is likely to be very difficult.

Blaming whoever is currently unpopular may get fools elected to public office, but it can only make it even more difficult to solve problems. Such blame shifting is not merely unhelpful. It’s poison.

Democracy has many advantages. But there are disadvantages as well.

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There are 47 comments.

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  1. CJ Coolidge
    CJ

    I recently listened to a podcast by the great Tom Woods in which he discussed with guest David Gornoski the mimetic theory of Rene Girard (episode 1487). Central to this theory is the idea of the scapegoat as a means to deal with social conflict and other problems. When the enemy is too big or the problem is too complex to deal with directly, societies use the scapegoat mechanism to settle conflicts, or delude themselves that the problem has been (or is being) dealt with. You can see this going on with the scapegoating of pharmaceutical companies. If you suggest that scapegoating drug makers does nothing to address the root causes of opioid addictions, or dare to criticize the sacred cow of the State, you risk raising the ire of the angry mob.

    • #1
    • September 13, 2019, at 7:49 AM PDT
    • 7 likes
  2. Rodin Member

    @drbastiat, my summary of your post is: Be aware that the cure can become worse than the disease. Drug addiction is sometimes a result of a belief that life shouldn’t be this hard and that we are due a palliative for any and all complaints. 

     

    • #2
    • September 13, 2019, at 8:33 AM PDT
    • 6 likes
  3. John H. Member

    In the remainder of the article, they blame doctors, pharmaceutical companies again, lack of education, and pharmaceutical companies yet again. But they never mention those who took the drugs or those who bought the drugs.

    Because that would involve asking them about their motives and actions, and that’s Just Not Done.

    In his book Travels, which was far more revealing on the subject of medical education than it was on travel, Michael Crichton spoke of asking his patients why they got sick. He’d got the idea from I believe a Swiss physician who’d ask skiers why they’d broken bones…and who got frank and informative replies. His patients were not insulted by the questions’ implicit fixation of blame. Crichton rather daringly took the same approach with people who’d had heart attacks: WHY did YOU have one? And he found that his patients, like those skiers, did not attribute their troubles to accidents or bad luck. They felt no small responsibility for what had befallen them.

    But I don’t think that approach or that philosophy ever caught on. Crichton stayed in medical school just long enough to get his degree, and the rest is history.

     

    • #3
    • September 13, 2019, at 8:34 AM PDT
    • 10 likes
  4. Dr. Bastiat Member
    Dr. Bastiat Post author

    Rodin (View Comment):
    Drug addiction is sometimes a result of a belief that life shouldn’t be this hard and that we are due a palliative for any and all complaints.

    Very true. I was trying to point out that many social problems have similar roots to your description of drug addiction. Life shouldn’t be this hard. So we take a pill. Or we vote for somebody who says he’ll make it all better. That’s a lot easier than taking responsibility for ourselves. Liberty is difficult.

    My point is that this pattern is not just unhelpful, it’s dangerous.

    • #4
    • September 13, 2019, at 8:43 AM PDT
    • 7 likes
  5. Amy Schley Moderator

     I’d start with a bit of (paraphrased) wisdom from a recovering heroin addict I read at cracked.com: “The hardest part of quitting heroin was facing the problems I used heroin to escape from.” Happy contented people generally don’t try opioids, much less get addicted to them. 

    Why are people unable to face their problems and instead self medicate themselves into an oblivion of fixes and searching for fixes? 

    I have my list: the breakdown of the family so they don’t have married parents for role models, strong sibling bonds, or the social structure to make their own relationships work; the breakdown of social rules so people struggle to find a spouse; the implosion of churches and social clubs so that people feel ever more isolated and lonely; the changes in the economy to require more mobility and training that many people aren’t willing to adapt to; the replacement of in person relationships with social media that makes one feel like everyone else is successful. 

    Some of these things are here to stay; the manufacturing jobs that are here and may even come back are not the kind of simple repetitive labor where you can even be tipsy without a problem. Social media itself isn’t going away, though there are things one can do to minimize its effects. 

    Some things we could do to alleviate these problems are eliminate marriage tax penalties and single parent tax breaks, grow our churches and social clubs, get rid of zoning laws and other rules that artificially inflate housing prices which force more families into having two full time working parents.

    We can’t legislate people into not trying to escape their overwhelming problems, which is why a war on drugs will never work. But we could work on minimizing those overwhelming problems into something people feel competent to overcome instead of just shooting up to hide from them. 

    • #5
    • September 13, 2019, at 9:13 AM PDT
    • 6 likes
  6. Midget Faded Rattlesnake Contributor

    Dr. Bastiat: People now expect to be pain free? People are less willing to accept the difficulties of life and want a pill to make it go away? People are not as tough as they once were? People are unhappy or stressed out and like drugs that dull their anxiety etc? The 60’s taught people that there are better drugs available than booze? People have lost hope for the future and just want to feel good today? Marijuana distribution networks make it easier to get opioids into typical communities? I could guess and guess and guess – I really don’t know what has changed. But something has changed. Something really, really big.

    Dr. Bastiat: I think that one reason that so many social problems go unsolved is not that we can’t find the solution. It’s that we don’t want to find the solution.

    You say you really don’t know what has changed. You also suspect our primary obstacle to knowing is our not wanting to know. Do you include yourself, then, in that suspicion?

    I tend to think things are not so cut and dry — that it’s possible a question we might not like the answer to can also be quite difficult to answer, even for the willing. But I do wonder if you’re also blaming your own lack of knowledge on maybe not really wanting to know.

    • #6
    • September 13, 2019, at 9:44 AM PDT
    • 5 likes
  7. Blondie Thatcher

    Dr. Bastiat (View Comment):

    Rodin (View Comment):
    Drug addiction is sometimes a result of a belief that life shouldn’t be this hard and that we are due a palliative for any and all complaints.

    Very true. I was trying to point out that many social problems have similar roots to your description of drug addiction. Life shouldn’t be this hard. So we take a pill. Or we vote for somebody who says he’ll make it all better. That’s a lot easier than taking responsibility for ourselves. Liberty is difficult.

    My point is that this pattern is not just unhelpful, it’s dangerous.

    The only part of last night’s debate I heard was how racist the country is because of all the “people of color” in prison. It’s not because the person is responsible for his illegal behavior, it is because the country is racist. Liberty is difficult. 

    • #7
    • September 13, 2019, at 10:00 AM PDT
    • 6 likes
  8. Mendel Member

    This topic is fairly important to me, if for no other reason than my own self-interest, as one of the companies now being asked to fork over the lion’s share of its liquidity pays my bills.

    One thing that strikes me is that the overprescription of pain medication and the opiate addiction crisis may only be coincidentally linked. What I mean is that the crisis of drug addiction in “rust belt America” is most likely triggered by the numerous causes Amy lists, not by the overprescription of legal pain medication.

    Rather, the reason this wave of budding addicts ended up choosing opioids as their illicit drug of choice is due to the coincidence that those were the drugs most easily available at the time (due to the ill-advised trend of generous pain medication prescriptions). 

    In other words, if pain medication hadn’t been so easily available, I am convinced we’d still have an addiction crisis in the former industrial areas of the US – it would just be with a different drug. Which is why I think it’s important to consider the addiction crisis and the overprescription of pain medication as two distinct topics, even though they obviously overlap greatly.

    • #8
    • September 13, 2019, at 10:01 AM PDT
    • 14 likes
  9. Dr. Bastiat Member
    Dr. Bastiat Post author

    Midget Faded Rattlesnake (View Comment):
    You say you really don’t know what has changed. You also suspect our primary obstacle to knowing is our not wanting to know. Do you include yourself, then, in that suspicion?

    Good question. I’m not sure, I suppose. Maybe a bit, although I hope not.

    • #9
    • September 13, 2019, at 10:02 AM PDT
    • 1 like
  10. Mendel Member

    With all that said, the pharmaceutical industry certainly bears some complicity.

    For example, the exuberance over oxycodone was simply naive. The notion that simply switching to a delayed-release form of a well-characterized, potent, highly-addictive substance would eliminate most of its dangerous drawbacks was simply delusional, yet it was marketed with a very high degree of certainty regarding its safety even before long-term experience with its use became available.

    For another example, pharmaceutical companies are hyperaware of their drug sales, and given the statistics on how many prescriptions were being made in certain geographical areas of the US (in some counties more than 1 prescription per resident!), it must have been glaringly obvious that their products were being abused. At that point they had at least a moral duty (not to mention a legal one) to actively investigate and block abusive prescriptions.

    I’m not the right person to say whether fining these companies tens (if not hundreds) of billions of dollars is the answer. The proper response is to acknowledge their complicity without using them as a scapegoat. Whether society is capable of such an approach is far from clear.

    • #10
    • September 13, 2019, at 10:08 AM PDT
    • 6 likes
  11. Phil Turmel Coolidge

    So, let me make sure I understand: You want everyone to face the reality of their own problems so they can be solved?

    What are you? A conservative?

    • #11
    • September 13, 2019, at 10:30 AM PDT
    • 10 likes
  12. Amy Schley Moderator

    Mendel (View Comment):
    In other words, if pain medication hadn’t been so easily available, I am convinced we’d still have an addiction crisis in the former industrial areas of the US – it would just be with a different drug.

    Absolutely. Heck, look at things like social media and video game addictions: it’s self medicating with dopamine to hide from life, just considered a more socially acceptable form. 

    • #12
    • September 13, 2019, at 10:48 AM PDT
    • 9 likes
  13. Blondie Thatcher

    @drbastiat:”But that’s not the point. As a physician, I just don’t understand this lawsuit. We all know how addictive and dangerous these drugs are. We rarely used them until everybody from 60 Minutes to the CDC started screaming that people were suffering needlessly because heartless physicians were ignoring their pain, while withholding treatments that would reduce their suffering immediately. Then we had pain, the fifth vital sign. Rate your pain from 1 to 10. We were told that we were not treating pain aggressively enough, and you can understand that point of view. And presto, over-prescribing became a problem.”

     

    And if you don’t address their pain properly to the patient’s satisfaction your scores go down and it will effect your compensation (or at least that’s how the hospital works). 

    Sorry for the side track, but this has always irritated me. 

    • #13
    • September 13, 2019, at 10:56 AM PDT
    • 4 likes
  14. Midget Faded Rattlesnake Contributor

    Mendel (View Comment):
    With all that said, the pharmaceutical industry certainly bears some complicity.

    What I heard (and I don’t claim to be in a position to verify it) is that the push for

    Dr. Bastiat: pain, the fifth vital sign

    was sponsored in part by pharmaceutical companies — that these companies supported the Joint Commission on pain which led to the new, more opiate-friendly, standard of treatment. The Joint Commission is, as far as I know, a private body, but one with some clout.

    Could some form of indirect regulatory capture (interests capture a private advisory body which turns out to have clout with the regulators) been at play here?

    • #14
    • September 13, 2019, at 11:02 AM PDT
    • 3 likes
  15. Henry Castaigne Member

    Dr. Bastiat: But every story needs a bad guy.

    This is one of the most important observations about how humans think and communicate that anyone has ever said and it explains the power of the leftist position. Stories matter more than evidence and as much as postmodernists wish it were otherwise, humans yearn for stories of good and evil.

    • #15
    • September 13, 2019, at 11:27 AM PDT
    • 7 likes
  16. Addiction Is A Choice Member

    Addiction is a choice! 

    • #16
    • September 13, 2019, at 11:50 AM PDT
    • 11 likes
  17. Henry Castaigne Member

    Mendel (View Comment):
    For another example, pharmaceutical companies are hyperaware of their drug sales, and given the statistics on how many prescriptions were being made in certain geographical areas of the US (in some counties more than 1 prescription per resident!), it must have been glaringly obvious that their products were being abused. At that point they had at least a moral duty (not to mention a legal one) to actively investigate and block abusive prescriptions.

    Assuming everything you say is true, it wasn’t just companies selling drugs that created the situation we are in. It was people buying them. The buying them part has changed. 

    • #17
    • September 13, 2019, at 11:54 AM PDT
    • 2 likes
  18. Vance Richards Member

    Amy Schley (View Comment):
    I’d start with a bit of (paraphrased) wisdom from a recovering heroin addict I read at cracked.com: “The hardest part of quitting heroin was facing the problems I used heroin to escape from.” Happy contented people generally don’t try opioids, much less get addicted to them. 

    Good point. I once heard a former addict giving his testimony at church and one line really stood out to me. He said, “People think drugs are the problem but for me, drugs were the answer. The only time I felt good was when I was high.”

    • #18
    • September 13, 2019, at 11:57 AM PDT
    • 12 likes
  19. Quietpi Member

    There are a couple elements to this whole thing that I have a problem with: First is the idea that “nobody knew” that these prescription opioids were addictive. That’s absurd. The first case I dealt with, involving addictive drugs involved… vicodin. The year? I think it was 1975. And I know through interaction with doctors themselves, they knew what they were dealing with, and refused to over – prescribe. Of course there were exceptions re: unscrupulous doctors out there, but that wasn’t what I encountered personally.

    The second is the absence of a statistical breakdown of how many of these opioid deaths are the result of meds that were actually prescribed, vs. illegally obtained.

    BTW I knew, and openly predicted, that with the liberalization of marijuana laws, there would eventually be a big increase in all other forms of drug abuse. Shazzamm! How could I possibly predict that?

    A case I worked on a while back: “Victim” fell off the back of a motorcycle that was making a slow, left turn in a neighborhood. “Victim” was transported by ambulance to the civilian hospital, complaining of terrible pain.

    SUBJECTIVE: Excruciating pain all over body.

    OBJECTIVE: A few scrapes and bruises.

    ASSESSMENT: Minor injuries from a traffic accident. Patient is a known “doctor shopper.”

    PRESCRIPTION: Tylenol. Other Rx ruled out by patient’s medical history.

    “Victim” was not a happy camper. At least one return to the hospital in the next day or two, with the same complaint, same result.

    “Victim” did end up getting her drugs – from the V.A.

    • #19
    • September 13, 2019, at 12:10 PM PDT
    • 7 likes
  20. OmegaPaladin Moderator

    Here’s the problem: both the unwillingness to treat pain patients and the massive quantities of drug-seeking behavior are problems. We need to be cautious in acting so that we don’t make one side of the problem worse.

    I would also agree with @mendel that it is likely that opiate addiction is likely a separate problem from medical opiates. The people I know who took pain medication tried to keep their dose low since they did not like the side effects. It is quite possible that the people who are becoming addicted are doing opiate pain medications since they are available, not because they are specifically bad drugs. In fact, some of the overdoses are happening because the addict switches to a street drug once the pain pills are not available.

    Some people would like to forget about the world for a while. Seeing the way the world is portrayed in the media, can you blame them? I think it would benefit from a deeper analysis, but I also think promoting more healthy methods of escapism is a good thing.

    • #20
    • September 13, 2019, at 12:13 PM PDT
    • 4 likes
  21. Yehoshua Ben-Eliyahu Coolidge

    Having worked with addicts for many years, the most consistently proven way out of addiction is to meet regularly with a group of other addicts, based on the AA (Alcoholics Anonymous) model. This is a spiritually based approach that works for those who stay committed and involved. The cornerstone of its success, other than regular meeting attendance, is the buddy system. Newbies trying to stay sober find a sponsor who has been sober for a decent period of time. You can call your sponsor any time of the day or night, no matter when you feel the need to use, for positive reinforcement of your new found sobriety. Doctors and nurses should refer anyone dependent on opioids to such an addiction recovery group.

    There is an amazing dynamic at work in AA which should be adopted by society at large since there are many people suffering from depression or situational challenges — loss of a job or a loved one, for example — who could use a buddy available to them 24/7.

    • #21
    • September 13, 2019, at 12:18 PM PDT
    • 11 likes
  22. Dr. Bastiat Member
    Dr. Bastiat Post author

    Yehoshua Ben-Eliyahu (View Comment):
    Having worked with addicts for many years, the most consistently proven way out of addiction is to meet regularly with a group of other addicts, based on the Alcoholics Anonymous model.

    You make very good points. I would also point out that in addition to AA’s emphasis on the power of God, it also emphasizes taking responsibility for one’s own behavior.

    • #22
    • September 13, 2019, at 12:33 PM PDT
    • 6 likes
  23. Addiction Is A Choice Member

    Yehoshua Ben-Eliyahu (View Comment):

    Having worked with addicts for many years, the most consistently proven way out of addiction is to meet regularly with a group of other addicts, based on the Alcoholics Anonymous model….

    And Step #1 is admitting that you are powerless…I have a problem with that: You are not powerless, you are powerful! In fact, you are so powerful, you are the only one who can do it! 

    But if meetings are your thing, hooray! Whatever it takes.

     

    • #23
    • September 13, 2019, at 12:35 PM PDT
    • 3 likes
  24. Old Bathos Member

    The opioid epidemic is not occurring in a vacuum. Sexual addictions and food consumption habits that once were reserved for the younger brothers of sultans and kings are now available to almost all of us. In the comfort of vehicles with A/C, ergonomic seats and stereo music we explode in lethal rage at those who would cost us an additional 5 to 20 seconds of traffic time. We have cinema options with an avalanche of content in our homes that our parents could not have imagined and with all that video entertainment we simultaneously isolate from each other while complaining that “there is nothing on.” And the quality and sensuality of home entertainment can only increase.

    There is a theory that alcoholism has a genetic basis and that natural selection acted upon populations as they first encountered fermented drinks–those most susceptible to alcohol addiction die off as it becomes available. Wine and grain alcoholic beverages began in the middle east and Mediterranean so those folks now have lower alcoholism rates than northern Europeans (Germans, English, Irish, Scots, Russians seem to have the tendency at approximately equal frequencies) who were a few thousand years behind. Northern Europeans are lower in turn than Native Americans for whom alcohol was and continues to be a devastating problem.

    The opioid crisis could be part of a larger problem that evolution did not equip us to handle a situation in which we could satisfy every craving, every appetite every pleasure center. Addiction (or a general heightened appetite for particular sensations) is now an option that low tech, low wealth ancestors were largely denied. Drugs that simultaneously tickle the pleasure centers while altering moods that would otherwise emerge from the awareness of unnatural, unhealthy behaviors are especially powerful.

    My favorite quote from Oscar Wilde is “There are only two tragedies in life: one is not getting what one wants, and the other is getting it.” The history of mankind was largely about the first one. Until now.

    • #24
    • September 13, 2019, at 12:40 PM PDT
    • 12 likes
  25. Midget Faded Rattlesnake Contributor

    Vance Richards (View Comment):

    Amy Schley (View Comment):
    I’d start with a bit of (paraphrased) wisdom from a recovering heroin addict I read at cracked.com: “The hardest part of quitting heroin was facing the problems I used heroin to escape from.” Happy contented people generally don’t try opioids, much less get addicted to them.

    Good point. I once heard a former addict giving his testimony at church and one line really stood out to me. He said, “People think drugs are the problem but for me, drugs were the answer. The only time I felt good was when I was high.”

    I can relate, if the drug in question is prednisone. Occasionally I’m prescribed prednisone, usually for asthma, and while the good feelings no longer happen every time I take prednisone, when they happen, they’re the best feeling I can remember in the world: it’s like finally feeling normal, only a just bit better.

    Now, prednisone is not known for being abused, or making you “high”. Primarily, it reduces inflammation. It’s a hormone and it monkeys with other stuff, too, including mood, sometimes (like increasing aggression). But it’s not a party drug. In my case, it only felt like a party because it happened to treat another underlying problem besides asthma, one that took over 30 years to identify correctly.

    Pain is weird.  I’ve written about this for Ricochet before, and in the years since, pain has only become weirder. Or rather, pain was always this weird, but the full extent of its weirdness is still sinking in. True, experiencing pain depends very much on psychological and social factors — but not in the way we often like to think. That is, moralizing cannot directly address why some brains amp up the pain so much more than others. You can’t really shame people out of pain, or hope that just making them feel worse about having pain will ultimately lead to them feeling better. Conservative culture — especially American conservative culture — is much enamored of the tough-love, no-pain-no-gain ethos, where it’s gotta get worse before it gets better. That turns out to work… surprisingly poorly… on chronic pain.

    It’s true people can do things to help get over their chronic pain, but effective nonpharmaceutical treatment turns out to be a lot more like candy-keistered, froofy, time-consuming European spa cures than many Americans (including me) feel comfortable with. Gently exercising your body in ways that help it feel safer sounds so un-American, doesn’t it? Not just new stimulus, but generally pleasant new stimulus? Where’s the hard edge, the eagerness to make it worse before it gets better, the eagerness to have it hurt so good because if it’s hurting, then you know it’s working?

    Getting back to self-medicating, people’s underlying problem doesn’t have to be an unrecognized medical problem (like mine was, although I’d like to point out I’m also an example that it can be), but general crapitude in their lives. @amyschley and @mendel have both addressed this pretty well. People aren’t crazy or immoral for letting general crapitude in their lives influence their perceptions of pain. Rather, they’re normal: pain is an adaptive alert system that is supposed to integrate cues beyond simple tissue sensation.

    • #25
    • September 13, 2019, at 12:42 PM PDT
    • 1 like
  26. MarciN Member

    I wish there were more counselors available to people with normal-life problems, as opposed to deep psychological problems–for example, job and marriage and family problems and money.

    We have pretty good systems in place for physical pain problems and for emergency problems such a person’s house burning to the ground or being leveled by a hurricane.

    But we’re not too good at helping, for example, someone in debt who is being plagued by collection agencies or someone who has been out of work a long time or someone whose children aren’t doing their homework.

    Sometimes those nonmedical problems cause severe anxieties that people are self-medicating to solve because they have no one to talk to. It’s really serious. We need a 24-hour emotional care place that would look like an ER but with conference rooms rather than examination rooms filled with hospital equipment.

    I think that would prevent some of the addiction problems we’re seeing.

    • #26
    • September 13, 2019, at 1:19 PM PDT
    • 2 likes
  27. Henry Castaigne Member

    Addiction Is A Choice (View Comment):

    Yehoshua Ben-Eliyahu (View Comment):

    Having worked with addicts for many years, the most consistently proven way out of addiction is to meet regularly with a group of other addicts, based on the Alcoholics Anonymous model….

    And Step #1 is admitting that you are powerless…I have a problem with that: You are not powerless, you are powerful! In fact, you are so powerful, you are the only one who can do it!

    But if meetings are your thing, hooray! Whatever it takes.

     

    Humans are intensely social creatures. We tend to not like doing things alone. Are there treatment programs for introverts?

    • #27
    • September 13, 2019, at 1:43 PM PDT
    • 4 likes
  28. Yehoshua Ben-Eliyahu Coolidge

    Henry Castaigne (View Comment):
    Humans are intensely social creatures. We tend to not like doing things alone. Are there treatment programs for introverts?

    Just to give one example. Someone who was assigned the task of making coffee at his regular AA meeting found that to be therapeutic, even though he did not mix with the other attendees. Just doing something for others, whether or not you chit-chat or socialize with them, can give you a sense of meaning which addicts often lack.

    • #28
    • September 13, 2019, at 1:58 PM PDT
    • 12 likes
  29. Mendel Member

    Old Bathos (View Comment):
    The opioid crisis could be part of a larger problem that evolution did not equip us to handle a situation in which we could satisfy every craving, every appetite every pleasure center.

    Another way to phrase this concept is that humans have been so utterly successful because we are hard-wired never to be happy with our status quo, but to always seek for something better. It is that inability to rest on our laurels that has driven so much of our incredible progress.

    But of course the core of that first sentence is: we are hard-wired never to be happy. While that’s not always true on the individual level, it is utterly apparent that on the aggregate, the human brain has a natural tendency toward unhappiness or dismay. And contrary to your other point, I don’t think natural selection necessarily weeds out the alcoholics: to the extent that the trait of not being able to find peace with one’s current situation may trigger both positive innovation and addiction, there’s actually a decent chance that a propensity toward addiction has been positively selected over the millenia.

    In any case, if we’re honest with ourselves, we need to admit that mass addiction is a fairly normal state of human existence. It’s always been with us, we just often don’t realize it because our forefathers didn’t find it worthy of recording in history books.

    Hence, I find most “our current addiction crisis is a reflection of how much we’ve lost our way” trains of thought unproductive. Yes, the current opiate crisis was triggered in part by economic downturn combined with the defraying of traditional social support networks. But human history also demonstrates that it doesn’t take much in the way of a downturn to induce people to kill themselves with dissociative chemicals.

    • #29
    • September 13, 2019, at 2:11 PM PDT
    • 4 likes
  30. Theodoric of Freiberg Member

    Dr. Bastiat (View Comment):

    I was trying to point out that many social problems have similar roots to your description of drug addiction. Life shouldn’t be this hard. So we take a pill. Or we vote for somebody who says he’ll make it all better. That’s a lot easier than taking responsibility for ourselves. Liberty is difficult.

    My point is that this pattern is not just unhelpful, it’s dangerous.

    It sure is dangerous. Just ask the people of Venezuela who voted in Hugo Chavez.

    • #30
    • September 13, 2019, at 2:54 PM PDT
    • 3 likes
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