Dr. Carl Hart. Is he right on drug use and addiction?

I came across Dr. Hart over the last few weeks after a couple of NPR stories about him. A fascinating guy. And a man who has, I think, the most practical solutions for dealing with drug abuse. Which, of course, have almost nothing to do with how we currently administer "solutions" to this problem.

Spend some time watching this Ted Talk. You won't be disappointed if you're interested in this issue.

http://www.tedmed.com/talks/sh...




I don't have time to watch it..but in my experience..the problem starts with doctors.  In the last 20 years, I have been to 2 types of doctors...1 is the type that hands out narcotics like candy and the other assumes I am just a drug seeking insane retard and blows me off and doesn't even attempt to assess and treat the injury in any way....no xray/mri, no non narcotics..nothing.  I have a chronic condition and sometimes have severe pain to the point I can't move---about 2x per year on average as long as I am careful not to trigger it most of the time.  I asked a doc for 10 pills per year...he gave me 80 every 30 months even when I kept saying I wasn't taking them...and then the nurse got mad at me for not filling the Rx.


Well, I recommend watching the video, though maybe I'll post some links where you can read his thoughts.

His basic position is that our focus is all wrong. He maintains (and has significant research results showing the same) that there is no drug that is inherently addictive. The problem of addiction is not one of the effects of drugs, but the effects of some sort of deprived environment which leads people to ease their pain through drugs.

He maintains that the vast majority of drug users are actually "responsible" users. They manage to get through their everyday lives and responsibilities and still take drugs for "recreational" or other use.

Myths about the instant addictive nature of drugs like crack make the problem of anti-addiction policy even more problematic, since it is largely based on non-science.

Here's a short piece on him that lays out the basics.

http://www.nytimes.com/2013/09...

jmitw said:

I don't have time to watch it..but in my experience..the problem starts with doctors.  In the last 20 years, I have been to 2 types of doctors...1 is the type that hands out narcotics like candy and the other assumes I am just a drug seeking insane retard and blows me off and doesn't even attempt to assess and treat the injury in any way....no xray/mri, no non narcotics..nothing.  I have a chronic condition and sometimes have severe pain to the point I can't move---about 2x per year on average as long as I am careful not to trigger it most of the time.  I asked a doc for 10 pills per year...he gave me 80 every 30 months even when I kept saying I wasn't taking them...and then the nurse got mad at me for not filling the Rx.

As for your doctor, he seems to be a bit of an ***. I've gotten a few prescriptions for opiods over the last few years from a few doctors - mostly for post-surgical treatment - and the prescriptions have all been for limited amounts and were non renewable.


People get addicted to avoiding reality, not to drugs.  The drugs are just a tool for avoiding reality.  The myth that prescribing opiates creates drug addicts only hurts people who truly need pain medication and aren't receiving it due to the fear of abuse.  If someone has issues with reality and is seeking an escape, they will find it, whether it be through abusing prescription medication, illegal street drugs, or alcohol.  People will say "I knew someone who came from a good family, and became an addict after getting a script from a doc."  I say ********, plenty of people from "good" families have emotional baggage that they are dealing with, and if they want to avoid it bad enough they'll use whatever method is most convenient, whether it be sucking down a bottle of merlot every night, or getting a script from their doc. The escapism is the underlying issue that needs to be addressed, not the method used to escape. 


Yes, you're exactly right, and that's Dr. Hart's position. Problem is that drug policy is more focused on the drug itself rather than the behavioral issues. And that's why we haven't been successful.

spontaneous said:

People get addicted to avoiding reality, not to drugs.  The drugs are just a tool for avoiding reality.  The myth that prescribing opiates creates drug addicts only hurts people who truly need pain medication and aren't receiving it due to the fear of abuse.  If someone has issues with reality and is seeking an escape, they will find it, whether it be through abusing prescription medication, illegal street drugs, or alcohol.  People will say "I knew someone who came from a good family, and became an addict after getting a script from a doc."  I say ********, plenty of people from "good" families have emotional baggage that they are dealing with, and if they want to avoid it bad enough they'll use whatever method is most convenient, whether it be sucking down a bottle of merlot every night, or getting a script from their doc. The escapism is the underlying issue that needs to be addressed, not the method used to escape. 



I am talking multiple docs that don't prescribe narcotics appropriately.....not 1 doctor....


I can not speak to the scientific research.  It may be true for many cases.   I had a family member who had an older brother who was addicted to heroin.  As a result he never ever would touch drugs of any kind.  He drank in moderation.  He occasionally would have a beer when he came home from work, or he might have had a few beers at a party or barbeque.   This family member was prescribed opioid pain killers for chronic pain and became more horribly addicted than any human I have ever seen. Opioids gradually become ineffective and as that happens and the patient becomes more tolerant and more addicted the dosage must be increased.  So the doctor (who in my view is a criminal) just upped the dosage.   In my view many pain clinics are little more than legalized drug dealers.  But  that's beside the point.  So that research may be true in some cases. but for at least some who become addicted as a result of prescribed opioids I think it's inaccurate.


Oy, will the liberal absurdities never cease?



Gilgul said:

Oy, will the liberal absurdities never cease?

So non-liberals know how to interpret scientific findings? Talk about absurdity!


100% agree with this!

I grew up around drug addicts, long before Rx addictions were a "thing". These were good people from good families but like many of us, had varying degrees of coping mechanism skills for dealing with everyday life. 

Our society has an issue dealing with reality. Not to politicize it, but just look at Trump and his fan base. We all hear the same thing but some hear the "real" and some here the "fake news." To say to yourself, "God, I've been bamboozled" or "I've been lied to" or "I've been cheated and I believed in..." now means you have to deal with those feelings. How to do that? You have your Rx of Oxy and your back is hurting anyway...it's the rose colored glasses syndrome. That's why long after the back pain goes away, the Rx is still being popped. We like the feeling of feeling good; we often reject any version of feeling bad about ourselves, our careers, our families, etc. There's no Rx for that. 

spontaneous said:

People get addicted to avoiding reality, not to drugs.  The drugs are just a tool for avoiding reality.  The myth that prescribing opiates creates drug addicts only hurts people who truly need pain medication and aren't receiving it due to the fear of abuse.  If someone has issues with reality and is seeking an escape, they will find it, whether it be through abusing prescription medication, illegal street drugs, or alcohol.  People will say "I knew someone who came from a good family, and became an addict after getting a script from a doc."  I say ********, plenty of people from "good" families have emotional baggage that they are dealing with, and if they want to avoid it bad enough they'll use whatever method is most convenient, whether it be sucking down a bottle of merlot every night, or getting a script from their doc. The escapism is the underlying issue that needs to be addressed, not the method used to escape. 



+10

spontaneous said:

People get addicted to avoiding reality, not to drugs.  The drugs are just a tool for avoiding reality.  The myth that prescribing opiates creates drug addicts only hurts people who truly need pain medication and aren't receiving it due to the fear of abuse.  If someone has issues with reality and is seeking an escape, they will find it, whether it be through abusing prescription medication, illegal street drugs, or alcohol.  People will say "I knew someone who came from a good family, and became an addict after getting a script from a doc."  I say ********, plenty of people from "good" families have emotional baggage that they are dealing with, and if they want to avoid it bad enough they'll use whatever method is most convenient, whether it be sucking down a bottle of merlot every night, or getting a script from their doc. The escapism is the underlying issue that needs to be addressed, not the method used to escape. 




Tom_Reingold said:



Gilgul said:

Oy, will the liberal absurdities never cease?

So non-liberals know how to interpret scientific findings? Talk about absurdity!

In this case liberals are wishing away biology with their it is all society's fault crap.


Can't remember the source, but I heard (on NPR?) that apparently of the many (many many) US military who used drugs in Vietnam, the great majority stopped on return to the US, apparently not persistently addicted.  So just maybe environment and life circumstances do matter a lot?

The animals in the experiment cited in the NYT article above ignored the drugs when they had other attractive alternatives.  Maybe some who use drugs don't see other appealing options in their lives (This is in addition to the physical effects; once post-injury I was prescribed some codeine, and it was looovely, but I had a life to get back to, too.).

Hard problem, seems pretty clear it's not solved by jail sentences anyhow.


I would agree that addiction is not solved by a jail term. But addiction is biological. Some people use drugs and get addicted. Some can do so and just stop. It is all simply a result of the genetic lottery.



Gilgul said:

In this case liberals are wishing away biology with their it is all society's fault crap.

It's not all society's fault. There is collective and individual responsibility. It's foolish to say it is all one or the other. Your argument is a broad brush and a strawman. Liberals do tend to point out the collective problems, but we tell our children to take responsibility for their lives. We don't do so publicly, so maybe that's why you don't know this. Why should we do it publicly? It's a private matter. If you've ever met a liberal whom you consider to be successful by any measure, you're looking at someone who has taken personal responsibility. Doing so is more meaningful to me than talking about it. The characterization that liberals don't believe in personal responsibility is pure folly. We live it.


Gilgul says:  "It is all simply a result of the genetic lottery."

Somebody (not necessarily Einstein) says:  "Everything should be made as simple as possible, but not simpler."  http://quoteinvestigator.com/2...

I'm inclined to go with the latter.


That addiction is all the result of the the genetic lottery is as simple as possible but not simpler. Either you are genetically predisposed to get addicted if you use a certain substance or you are not. Nothing is going to change that and "society" does not impact that.


Show me the evidence that addiction is biological.


Gilgul said:

I would agree that addiction is not solved by a jail term. But addiction is biological. Some people use drugs and get addicted. Some can do so and just stop. It is all simply a result of the genetic lottery.




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