Fentanyl Poisoning and Passive Exposure

/ bs king / 2 Comments

The AVI sent along this article this week, which highlights the rising concern about passive fentanyl exposure among law enforcement.  They have a quote from a rehab counselor who claims that just getting fentanyl on your skin would be enough to addict you, and that merely entering a room where it’s in the air could cause instant addiction. Given that it’s Reason Magazine, they then promptly dispute the idea that this is actually happening.

I was interested in this article in part because my brother’s book contained the widely reported anecdote about the police officer who overdosed just by brushing fentanyl off of a fellow police officer. This anecdote has been seriously questioned since. Tim expressed concerns afterwards that had he realized this he would have left it out. I’ll admit that since my focus was mostly on his referenced scientific studies, I didn’t end up looking up various anecdotes he included.

This whole story indicates an interesting problem in health reporting. STAT news has more here, but there’s a couple things I noted. First, the viral anecdote really was widely reported, so I’m not surprised my brother heard about it. It has never technically been disproven….outside experts have said “it almost certainly couldn’t have happened this way” but neither the police officer nor the department have commented further. This makes it hard for the “probably not” articles to gain much traction.

Second, the “instant addiction” part was being pushed by a rehab counselor, not toxicologists who actually study how drugs interact with our body. Those experts point out that it took years to create a fentanyl patch that would get the drug to be absorbed through the skin, so the idea that skin contact is as effective as ingesting or breathing it in seems suspect.

Third, looking at the anecdotes, we realize these stories are NOT being reported by the highest risk groups. Pharmacists would be far more likely to accidentally brush away fentanyl than police officers, yet we do not hear these stories arising in hospital pharmacies. Plenty of patients have been legally prescribed fentanyl and do not suffer instant addiction. The fact that the passive exposure risk seems to only be arising in those who are around fentanyl in high stress circumstances suggests other things may be complicating this picture.

While this issue itself may be small in the grand scheme of things, it’s a good anecdote to support the theory that health fake news may actually cause the most damage. While political fake news seems to have most of our attention, fake or overblown stories about health issues can actually influence public policy or behavior. As the Reason article points out, if first responders delay care to someone who has overdosed because they are taking precautions against a risk that turns out to be overblown, the concern will hurt more people than it helps. Sometimes an abundance of precaution really can have negative outcomes.

Asylum Claims and Other Numbers at the Border

/ bs king / 3 Comments

There’s a lot in the news right now about border crossing, immigration and asylum claims, and I’m seeing all sorts of numbers being thrown around on Twitter. I wanted to do a quick round up of some numbers/sources to help people wade through it.

First up, every month US Customs and Border Patrol publishes the number of apprehensions they have at the Southern US Border and how that compares to the last 5 years. They do this relatively close to real time, we have the numbers for May, but not yet for June. If you want to know why you’re seeing so much in the news, take a look at this graph:

So with 4 months left to go in the fiscal year, we’re already 100,000 over the highest year on that chart. To give some context to that though, apprehension numbers have actually been relatively low for the last few years. They peaked at 1.6 million in the late 90s/early 2000s. However, there have been some changes to the makeup of that group….family crossings. Vox published this chart based on the CBP data that shows how this has changed:

I couldn’t find what those numbers were during the last spike, but it seems to be a record high.

So now what about asylum claims? Recently acting DHS Secretary Kevin McAleenan said the 90% of asylum seekers were skipping their hearings, but others were claiming that actually 89% show up. That’s a MASSIVE discrepancy, so I wanted to see what was going on.

First up, the 89% rate. The DOJ publishes all sorts of statistics about asylum hearings, and in this massive report they showed the “in absentia” rates for asylum decisions (page 33):

So for FY17, asylum claimants were at their decision hearing 89% of the time.

So where did the “90% don’t show up” claim come from? Reading the full context of McAleenan’s quote, it appears that he was specifically referencing a new pilot program for families claiming asylum. From what I can tell the pilot program is not published anywhere, so it’s not possible to check the numbers.

So is it plausible it jumped from 11% to 90%? I tend to doubt it, but it’s important to note the lag time here. The last published DOJ numbers are from FY2017, but those are for hearings that took place in FY2017. The average wait time for hearings in these cases for these cases is enormous….727 days so far in 2019.  These wait times are climbing, but if you toggle the graph around, we can see that the wait time back in 2015 was nearly two years:

So essentially those with decisions in FY2017 probably filed in FY2015. And a lot has happened to the stats since then. First, here are the number of applications over the last few years:

So compared to 2015, the number of applications have tripled but the number of approvals has barely budged. We don’t yet know what that will do to the percentage of people who show up, but it seems very plausible that it could increase the absentee rate. Additionally, because family migration is increasing so rapidly, it’s not clear what that will do to the numbers. Regardless, McAleelan’s reference was specifically to that group, so it was only a subset of the numbers that were previously reported. Still, 90% seems awfully high.

Complicating things further of course is the fact that this was a “pilot program”. That means it could have selected just one country or point of entry. One of the more interesting fact sheets from the DOJ site was the rate of asylum approvals by country. In the past few years, here are the top countries (page 29 of this report):

The rates of granting asylum from each of these countries were wildly different in 2018 though. Chinese asylum seekers were 53% granted, El Salvador was 15%, Honduras was 14%, Guatemala was 11%, Mexico was 6%. It seems plausible that a pilot program might have just been addressing those that arrive at the southern border, so it’s possible that individual countries have different profiles.

Overall, it’s clear that the data on this topic is worth watching.

Twitter and Sundry

/ bs king / 1 Comment

I finally got a vacation this week, which means I spent not a lot of time near a computer but had a decent amount of time to scroll through Twitter. A few good accounts I found:

Any other good ones I missed?

Speaking of good accounts to follow, apparently one of the first papers focused on a prominent (and anonymous) Twitter account was published, with this one on the role of Neuroskeptic in calling out scientific ethical breeches. Only paper I’ve ever seen where the conflict of interest statement included “…was banned from commenting by Leonid Schneider at his blog “forbetterscience”.

Finally, Neuroskeptic also follows up on an analysis done by Susan Fiske of who research methods blogs go after and how often.  A few years ago Fiske had caused a kerfluffle when she referred to many science/research methods bloggers as “methodological terrorists” and defended the replication crisis. Her new paper looks at 41 bloggers and categorized which other researchers they talked about most often. Interesting findings: 3 out of the top 4 talked about researchers resigned (Diederik Stapel,  Brian Wansink and Jens Förster), , and the #1 guy is pretty notorious. Other interesting note: there was no clear gender bias in who got talked about. Men were more likely to critique other men, and men who got named were posted about more often. However, it’s not particularly clear what this means about bias, as a few large cases of misconduct got a LOT of coverage, and Bem seems to have become the go to for bad methods/good researcher examples.

Still, super interesting work and good for Fiske for doing it. Gotta respect someone who gets mad, then gets data. I look forward to this being expanded on in the future.

Vaccination Rates by County, State and Around the World

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There’s a lot in the news recently about vaccination rates, both in the US and in other countries. After seeing a few comments on Twitter this week about the topic, I got curious about the exact numbers.

First off, it’s important to note that for all the press coverage of the measles outbreak, vaccine exemptions are not evenly distributed across the country. For example, here’s just my state broken down by county. The map on the left is those with exemptions, the one on the right is those without exemptions not meeting requirements. Functionally, the vaccination rate is likely 100%-(the number on the left+the number on the right).

Source.

Now not everyone on the right may be missing their vaccinations, for some it may be paperwork. The Boston suburbs probably do well because most working parents have been providing vaccination documentation to day cares for years prior to this.

So how does Massachusetts compare to the country? Well, the CDC puts together a rather awesome interactive map for Kindergarten vaccination rates here. This map shows something interesting. Per the NYTs graphic of the measles outbreak, Washington, New York and Michigan have seen the largest measles outbreaks in the country. However, New York actually has one of the highest vaccination rates in the country at 97.5%. This suggests that it’s not just having a high vaccination rate, but where the unvaccinated are located that causes outbreaks. For example, in Massachusetts the exemption rates are highest on Martha’s Vineyard, a wealthy spread out community with not many year round residents. The other counties with higher rates of exemptions are not close geographically. In New York City though, it’s groups living in close proximity with low rates that are getting hit by the outbreak. This leads to high overall vaccination rates by state, yet still record setting outbreaks in targeted communities.

Now how about worldwide? Well, after working on their childhood vaccination program for years, Mexico actually now has a higher rate of children vaccinated against measles than the US (96% vs 92%). Interestingly, a similar number of people doubt vaccination safety in both countries. According to Our World in Data, France and Russia have the most vaccine skeptics:

Using Our World in Data again though, apparently vaccine skepticism doesn’t always correlate with not getting vaccinated. Both France and Russian have >95% measles vaccination rates.

I thought all this was interesting because overall, many people believe that fewer children are vaccinated than actually are. For example, Americans estimated that only 35% of the worlds children were vaccinated against measles, when in reality 85% are. While knowing that rates are high can sometimes convince people that it doesn’t matter as much if they get their kids vaccinated, thinking many people aren’t vaccinated can sometimes convince people that it’s not important to do so. “Everybody’s doing it” is an effective slogan for a reason.

 

Quote for Election Season

/ bs king / 1 Comment

Life is a bit chaotic this weekend, but as we head towards what looks to be a rather drawn out election season, here’s a quote to keep in mind:

“The public’s ‘opinion’ on almost any issue will be a function of the question asked.”
-Neil Postman, Technopoly (as found on Twitter)

The exact wording here is important…”a function of” does not mean the question fully makes the opinion, but rather that it transforms it in ways that can often be predicted. A good thing to remember when you see headlines saying “the public supports ______” or “low public support for _______”.

Addiction Nation: Recovery and Hope

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This post is part of a series about my brother’s upcoming book Addiction Nation: What the Opioid Crisis Reveals about Us, discussing some of the science and stats he used throughout the books. Read the intro post here, part 1 here, part 2 here, part 3 here, or (best of all) pre-order the book on Amazon here. Only 2 more days until the release!

We’ve spent the last few weeks looking at a lot of areas of addiction, but (much like your book) I wanted to end this series on a positive note….talking about recovery and hope. Of course one of the biggest reasons people want to read about addiction is precisely to find hope, so I think it’s a good place to end. Sound good?

Tim: Awesome! I wanted to note one other hopeful thing up front. There are some pretty terrible treatment programs out there. I didn’t get into the corruption or the number of facilities that don’t use evidence-based treatment methodologies. They really do have low success rates. 

One critical thing to look at is how specific studies define “success.” If they only definition of “success” is total abstinence for a person’s entire life (or even just the length of the study) then a lot of numbers are going to look pretty grim.  But, if success is defined by decreasing overdoses, a reduction in harmful behavior or even just using less of the substance, then there is a lot of reason to hope. 

Another thing I didn’t get to dive into is “spontaneous remission” or when a person recovers from an addiction without any professional treatment. It happens a lot more than you would expect. This means that increasing access to treatment is really important but we can also save a lot of lives by trying to keep people alive long enough for that spontaneous remission to occur. 

Ooooh….defining success metrics clearly. I like it.

Okay, so first up, last week we talked about the Rat Park study, and you mentioned a study that often gets brought up with that one. It’s a 1974 study called “How Permanent Was Vietnam Drug Addiction?“, and it looked at the rates of addiction among American soldiers in Vietnam as they were leaving Vietnam, then got back in touch with them after they got home. The results are here:

The most often quoted statistic (and the one you use in the book) is the amazing drop from 20% reporting an addiction issue to just 1% reporting an issue a year later. It’s an incredible statistic, made stronger by the fact that this study had a very low non-response rate (<5%) and that urine testing backed up the self reported usage. You quote the study as saying:

There have been no studies of addict populations in this country that show anything like the 95 percent remission rate after ten months, which is what a drop from 20 percent addicted while in Vietnam to 1 percent after Vietnam suggests.

I can see why that stat gets all the headlines, but one of the things I found most interesting about this study when I dove in to it was that there’s actually a lot more in it for us to think about. You weren’t able to get in to it in the book, but I found their breakdown of the subgroups within that group fascinating:

So basically 85% of soldiers returned to their pre-Vietnam status. 8% who had used before Vietnam actually stopped using after returning from Vietnam, and 7% who weren’t using before started using and never stopped.

Now the authors throw in a caveat here that just because these veterans stopped using narcotics doesn’t mean they didn’t pick up another problem (alcoholism, barbiturates, etc), and they note that those who continued their addiction tended to have a much bigger problem than they did before going to Vietnam. However, even with those notes, this does fly in the face of the idea that using narcotics will always lead to a permanent addiction problem with that particular substance.

Tim: Absolutely. There is a good reason to believe that this is the norm, not the exception. This is why “heroin-assisted treatment” has been pretty well documented to be effective in the long term. It reduces other health risks, like Hep C and HIV, provides consistent dosage and reduces drug-related crimes. While some people will just keep using indefinitely, a lot of others will experience spontaneous remission or eventually decide to engage in another kind of treatment. 

It also indicates that there are almost certainly people who might be more “situational” addicts, and we may need to treat them differently from those whose addictions seem more persistent. Looking at your story, one could call you a “situational” addict, don’t you think? Any thoughts on this?

Tim: The Vietnam study was actually the inspiration for Bruce Alexander’s “Rat Park.” I think Alexander would argue that almost everyone is a “situational” in their addictions. 

I wouldn’t want to create a strict duality but think this a better category for a spectrum, how big a role does your situation play? For alcohol consumption, there are a lot of folks who have problematic consumption levels that could be classified as alcoholism throughout college and into their twenties and early thirties. But, they eventually change their behavior in a way that is often triggered by major life events.  

But, in Switzerland, about 20% of people have continued using since the beginning of the heroin-assisted treatment program. This remaining population would probably be covered by life trauma, mental illness and some other genetic factors. 

While I focus a lot on environmental and social factors for addiction, you can’t escape some sort of genetic predisposition. Even if it isn’t necessarily for “addiction” but a bodily response to certain substances. 

For example, both us were prescribed opiates in high school/college for oral surgery. You took them and felt terrible. As soon as you could, you moved to ibuprofen because the narcotics made you feel sick. I finished the entire bottle, even though my surgery was less significant because I really enjoyed how they made me feel. 

That’s true. I get incredibly nauseous when I take opioids and have refused them ever since that surgery. Taking enough of them to get addicted would be a downright struggle for me.

Okay, to tease out one last part of that study, I found the entire idea that 8% of the men had a problem before they went to Vietnam but came back and stopped using totally fascinating. That’s pretty much the reverse of what we tend to think about with addiction….that traumatic events must always make it worse. With addiction though, we know this isn’t always the case. As you say in your book:

As discussed earlier, over time, severe addiction reduces the amount of gray matter in the part of our brain most responsible for higher-level reasoning and self-control. A 2013 study of the brains of those struggling with cocaine addiction suggests something interesting. Within a few months of sobriety, that gray matter began to return. Within six to twelve months, the gray matter had returned to baseline levels and was about the same as those who had never been addicted. But soon after that is when the most amazing thing happened: those areas began to form an even greater level of density than for those who had never used cocaine.

You got this from a study called “Dissociated Grey Matter Changes with Prolonged Addiction and Extended Abstinence in Cocaine Users“, which contained this very cool graphic:

So basically, substance use can get bad in a hurry because many substances actually erode the very parts of the brain that normally help us avoid doing impulsive things. Prolonged abstinence actually reinforces those parts of the brain beyond the baseline levels. As the study says:

If addiction can be characterized as a loss of self-directed volitional control , abstinence and its maintenance may be characterized by a reassertion of these aspects of executive function. Current cocaine users demonstrate reduced GM in brain regions critical to executive function, such as the anterior cingulate, lateral prefrontal, orbitofrontal and insular cortices. In contrast, the group of abstinent CD users reported here show elevations in GM as a function of abstinence duration that exceeds control levels after 36 weeks, on average, of abstinence.

They do note (as all good studies do) that they don’t really know causality here either. It could be that these addicts had above-average levels of grey matter beforehand (they were not measured pre-addiction) or it could be that recovery caused them to grow more grey matter than they originally had. It could be a little of both. It’s pure anecdote, but based on what I’ve seen out of successful recovered addicts I’ve known, I’d say the change is real.  How about you? On a personal level, do you feel addiction and recovery changed your brain at all?

Tim: My struggle would be classified as a relatively mild opioid use disorder. While the addictive process at work certainly would have changed my brain it would have been less significant than if it had gone on for years or decades. Since the initial change was not as substantial I don’t think my process of recovery likely changed things as much. 

I have been amazed that whenever I talk with someone who is also open about their recovery, there is often a sense of connection because there are different truths we’ve realized about ourselves that creates a kind of bond. 

Three thoughts related to that. 

First, I wanted to tell my story because early detection matters. If you are able to see what is happening and get support early on, recovery won’t be as difficult. I think a lot of people end up letting an addiction progress because of the shame and stigma that surrounds it. Admitting you are feeling out of control seems like a life and world ending admission. That makes it harder to do. 

Second, I do think this journey has led me to a place of diving deeper into the techniques of cognitive behavioral therapy. My research in that area made me realize how important those tools can be for improving my outlook and life more broadly. Writing a book about opioid addiction made me reflect on my alcohol consumption. It isn’t problematic at the moment but if I was to continue to drink 1-2 more alcoholic beverages a week for the next 10-20 years, there could be significant negative effects. So, I’ve started using what I’ve learned to be more thoughtful about the role alcohol plays in my life. 

Third, has been a deepening of my own spiritual and religious practices including various forms of meditation and prayer. Mindfulness training is now integrated into a lot of different recovery practices. Even though I don’t feel a day to day tug towards opioid usage, I’ve tried to dig into these practices that could provide some anchoring because I am now well aware how easily the addictive process can kick up. 

Alright, well that wraps up the series! If you want to see more from my brother, take a look at his book/author page here or buy the book and get it on Tuesday! Anything else you want to say to the nice people Tim?

Thanks for reading and I’m sure I’ll be back some time soon!

Agreed! You didn’t put it in the book, but I’d love to dig more in to the research around some of the heroin assistance programs. Crazy stuff.

Thanks for posting brother, and thank you so much for letting me opine on your work. It’s been an honor to go through so much of this journey with you, both the addiction part and the book writing part. I’m proud of you on both counts, and can’t wait to see what’s next in your journey.

Addiction Nation: Controversial or Disputed Research

/ bs king / 3 Comments

This post is part of a series about my brother’s upcoming book Addiction Nation: What the Opioid Crisis Reveals about Us, discussing some of the science and stats he used throughout the books. Read the intro post here, part 1 here, part 2 here, or (best of all) pre-order the book on Amazon here.

Okay, so last week you heard about how Tim had to change a few things around when we read the actual research. Today I wanted to talk about a few pieces of research that were included in the book that have some controversy around them. While there’s only so much you can fit in a book, we thought the blog might be a good place to expand a little on some of the studies quoted. How does that sound brother?

Tim: Perfect! This was another tricky area of wading through a lot of conflicting information. One thing that I don’t think your readers will be surprised by is that the reason some of these studies are controversial is not always about the studies themselves but the claims or coverage that comes out of them.

For example, the claim “environmental factors play a role in addiction” isn’t controversial. What is controversial is when a study is used, or it’s author claims, that they have demonstrated that environment is ALL or most of what matters.

My general standard was to imagine a reader diving into a specific study in more detail. As they read, would they feel like they were learning nuance and adding texture? Or would the feel like they were misled?

That sounds like a pretty reasonable standard to me! And yes, “blame the journalist” has been a catchphrase on this blog since the very beginning. Coverage of studies can certainly skew perception of the study in ways authors never intended.

Alright, first up, a study I’ve actually blogged about before “Rising morbidity and mortality in midlife among white non-Hispanic Americans in the 21st century“. Before we get to the meat of this, I gotta point out brother, you actually got the name of this study wrong in your citation list. You called it “Rising morbidity and mortality, US Whites”. I mean I know I’m the only one who’s gonna read through all your citations, but GET. IT. TOGETHER. Luckily for you the author, journal, year, and DOI number were all correct, so I’ll let this one slide.

Edited even before Tim could reply: I actually just figured out how this happened. On the study page I just linked to if you click “citation manager” it changes the name of the study to the one Tim used

I take it all back brother, you’re okay.

Tim: Oh dear readers… You have no idea how sweet this is. I tried to find an emoji for the feelings you feel when your sister who is always right isn’t right but I just couldn’t find one that could encapsulate how great I feel right now. 

Okay, okay, simmer down here kiddo. I actually was right. The name of the paper you used in your citation list isn’t the one it was published under. I was just clarifying that your error wasn’t your fault.

Anyway, your quote in the book about this study (Chapter 7) is this:

After decades  of declining mortality rates – primarily because of gains in treating cancer and heart disease – the likelihood of a white person dying between the ages of forty-five and fifty four has gone up. A similar trend has not been seen in any of the world’s wealthiest nations……The change was driven was driven almost entirely by drug -and alcohol-related liver disease, and suicides.

You use the study above to support this quote, and you accurately state what the study concluded. However, there have been a few follow ups that I blogged about here.

First, Andrew Gelman questioned the findings of the initial study, citing cohort effects as possible confounders. Then, another study came out that suggested that the overdose increase was real, but not the suicide rate increase.  Then in 2018 the CDC released a report that showed that suicide rates were at a 50-year peak. They didn’t specifically quantify based on race, but they did show that rural areas (which tend to be whiter) were more vulnerable.

There’s a lot going on here, but I think overall it seemed like a reasonable quote for you to leave in. I’d say one of the big challenges of editing a non-science book for scientific accuracy is how to explain things like this without derailing the whole book. The point of your chapter was supposed to be Despair and Acedia, not demographic trends.  It seemed like the initial study got enough right that it was worth quoting, but I still feel like we’re refining the details. Personally, I would have put more of that in, but I know you had space limitations.  Any thoughts on this?

Tim: More got cut from this book than made it in the final copy. Final word count is around 70,000 and I left 100,000 words on the cutting room floor. That isn’t just rewrites but all the sections and chapters that didn’t make the final cut. It is tough to figure out how much space you can dedicate to the nuances or follow ups of specific studies.  

And with the specific details of which “deaths of despair” were most responsible, it gets pretty complicated. My guess is there will be some back and forth about this for a while because of how hard it is to feel confident in how deaths are categorized.  

There is a real human somewhere who needs to go through and catalog cause of death. And, whether or not someone died by suicide or via an accidental overdose is a line that is not always clear. Social norms or even the kind of reporting forms used can influence how these numbers are counted. 

We will also likely see studies in the future that see what sort of effects the high overdose rate will have on those who might have died later from alcohol-related health issues or by suicide. The main question there being whether or not these deaths are concentrating when in previous cohorts they would have spread more evenly over several decades. 

The lines are blurry enough for me that I felt the overall point about “deaths of despair” stands even as researchers try to parse out in greater detail what is going on. 

Alright, next up we have the infamous Rat Park study. From the work of Bruce Alexandar, this is one of the most quoted studies on addiction. Basically, the researchers put rats in empty cages with morphine and noted that the rats became addicted very quickly. They then put them in a nice environment and discovered that they rarely got addicted to morphine. This study is often used to prove that when it comes to addiction, environment matters more than exposure to drugs.

Now while I agree this study is interesting, I do have some concerns. Scott Alexander over at Slate Star Codex raised some issues with this study a few years ago with this post. He points out that while some studies have mostly replicated the effect, other studies have not. More than that though, the two things that seemed to most stand out where:

  1. Genetics studies that produce results like this:
  2. The pretty observable fact that the rich and famous still have drug and alcohol problems. As the SSC post points out, Celebrity Rehab with Dr. Drew was canceled by the host after he said “he was tired of the criticism leveled at him after celebrities he treated had relapsed into addiction and died”. Given that celebrities have access to some of the nicest environments in the world, it seems hard to says it’s all about environment.

You nod to the controversy in the book with this note:

Alexander doesn’t deny that a wide range of other factors including genetics, life experience and individual choice plays a role, but he believes they need to be put into the background because of the power of the social forces at play.

That’s a good note, and you devoted a ton of time to the other factors elsewhere in the book. You seemed to end up with a pretty “big tent” view of addiction, acknowledging that pretty much every theory has some truth and value, but none are exactly right. It’s hard to express this in any one chapter though, without constantly caveating yourself. How did you end up feeling about this process? Any general thoughts on how much context people should give to studies like these, where the general premise is probably broadly true, but some of the specifics have questions?

Tim: After reading some of the critiques of this study, I considered taking it out. But then I got annoyed by some of the critics who claimed that the study had NEVER been replicated when it was actually mixed results from replications. 

I read Alexander’s book, The Globalization of Addiction, and felt comfortable that there is a pretty wide body of research establishing significant environmental effects when it comes to addiction. And, in the popular press and general cultural understanding of addiction, I still think these factors are not well understood or well known. 

This is why I included the study about returning Vietnam service members and indigenous populations. Different scientists, different approaches but affirming the same general points. 

I did have another paragraph providing a caveat about the role of poverty and that if wealth were all you needed then you’d never see the same celebrity on MTV Cribs and in the tabloids going off to rehab. But there was a longer section there that didn’t make the cut. 

The best framework isn’t connecting poverty and addiction but stress and addiction. Poverty is just one of the highly stressful experiences common in our world. But so was serving in Vietnam and, while I have no first-hand experience, so is being a celebrity.  

Another interesting area of inquiry is that there is good reason to believe that intermittent access to resources is actually more stressful than a consistent lack of resources. Our bodies respond poorly to highly fluctuating environments. That area of research could have been a whole chapter on its own. The one other area I touch on it is my chapter on the “body” where I look briefly at genetic/epigenetic factors related to addiction. 

Yeah, those are good points. The idea that stress and environment can play a roll in addiction seems pretty clear, though even your own story shows that can be complicated. You got addicted due mostly to large quantities of pain medication prescribed for a real need, but the tumultousness of your life at the time can’t have helped. For any critique of this study, even Scott Alexendar ended up saying the idea that ultimately unhappy people probably do more drugs than happy people seemed to be relatively self evident.  So I think there’s something to this, though clearly it’s not the whole story. Addiction is not something that happens in a vacuum, even if there’s more going on. As they say, genetics loads the gun, environment pulls the trigger.

Alright, so that’s it for this week! Come back next week for our final post, and in the meantime enjoy this picture of me holding the actual book my brother signed for me! GETTING EXCITED!!!!