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What Science Says to Do If Your Loved One Has an Opioid Addiction

fivethirtyeight.com

141–150 of 302 posts

Re: What Science Says to Do If Your Loved One Has an Opioid Addiction

#141
I do not agree with much of what is stated in this article, nor do I feel that this article represents "what science says" should be done if a loved one has opioid addiction (although it really goes into addiction as a general topic). Treating someone with addiction is a remarkably nuanced and challenging situation, and the author tries to present certain treatment options as not worth doing based on science, when their own citations do not back up those claims.

As someone who has had a loved one go through addiction, and ultimately die from that addiction, I find the binary nature of a lot of this self-described "evidence based guide" dangerously black and white. Proclaiming that abstinence based programs "have not been found to be effective" is total nonsense. What the study found in GB was that psychological only based treatment is less effective at preventing death than replacement therapy, on average. For many, replacement therapy may very well be the best option. For other, abstinence programs may give them an opportunity to fully reclaim their life. How about we empower medical professionals with the ability to treat the disease with a number of weapons, rather than creating this false dichotomy, which is not represented in the data. This guide would potentially discourage someone, or a family member, from choosing a very viable option for treatment, by overstating results.

While I'm not a medical professional, the best example I can think of is with how we treat depression. For some people, active psychotherapy is the best treatment option. For others, a regime of anti-depressants is sufficient treatment. For others, a combination of both is the optimum treatment option. What we don't do, as scientists, is say, "Option 2 has a 30% better outcome, thus we only will treat depression with option 2." That's just absolute junk. What it means is that we will look at what cohorts tend to respond best to option 1, 2, and 3, and understand why, so we can choose a treatment option that makes sense for that individual, without having to try 1, 2, and 3. It doesn't mean that we just toss out the other options wholesale.

The 538 politics podcast does a, "Good use of polling" and "bad use of polling" intro during many of their podcasts. This article would clearly fall under the category of "bad use of polling". I hope to see better out of 538 in the future on these topics.

Re: What Science Says to Do If Your Loved One Has an Opioid Addiction

#142
post #59
post #14

Earlier quoted context omitted.

I'm physically dependent on caffeine. Why bother fixing that when it is cheap legal and available?

In case you're looking for a sincere answer: being physically dependent on any otherwise unnecessary drug is a drag. You constantly have to seek it out to feel better. Even though caffeine is easily obtainable, I still have found it to be inconvenient when I've been at high levels of consumption. Plus, it does have health effects. It may not be so, but you'll likely feel a lot better without it.

I've gone cold turkey on caffeine a couple of times (takes me about a week of headaches, I'm not an especially heavy user), mainly because I was making hot drinks to avoid work out of boredom, so switched to ginger teas and such like.

Anyway, there doesn't appear to be consensus on whether coffee/tea drinking in moderate amounts is good or bad, but I've seen more suggestions that it's beneficial than otherwise. Any input to that?

Re: What Science Says to Do If Your Loved One Has an Opioid Addiction

#143
post #29

Earlier quoted context omitted.

> Withdrawal is hard. Just to emphasize that: Before my SO started working in a hospital, I had no idea that people going through alcohol withdrawal can end up in the ICU. They're ending up in an ICU because of the withdrawal, not the alcohol... That was really surprising to me.

Alcohol is one of the only substances on the planet that can cause you to straight up die from withdrawal alone. Deaths from opiate withdrawal are secondary, usually from falling during a seizure. But with alcohol, your heart can simply stop or your brain have a massive stroke from the withdrawal. We think it harmless because its legal, but alcohol is radically dangerous from an addiction standpoint.

Alcohol and benzodiazepines are the only ones, IIRC. In 2014, Xanax killed more people than fentanyl, morphine, and meth (https://www.usnews.com/news/articles/2016-12-20/heroin-cocai...)

Re: What Science Says to Do If Your Loved One Has an Opioid Addiction

#144
post #74

Earlier quoted context omitted.

Alcohol is one of the only substances on the planet that can cause you to straight up die from withdrawal alone. Deaths from opiate withdrawal are secondary, usually from falling during a seizure. But with alcohol, your heart can simply stop or your brain have a massive stroke from the withdrawal. We think it harmless because its legal, but alcohol is radically dangerous from an addiction standpoint.

That's interesting and makes alcohol sound pretty menacing. I should read more about it. It definitely sounds like seizures and heart issues come up the most. Plus their livers are shot, so toxicity of normally benign treatments is a concern. Also interesting that, in the very wealthy area we're in, outside of infants and the elderly, middle-aged white men going through alcohol withdrawal are the most common ICU pati…

FWIW, you can die from alcohol withdrawal well before your liver is shot. Also, you don't need to have been drinking for decades; you can get yourself in that pickle in months, not years.

Re: What Science Says to Do If Your Loved One Has an Opioid Addiction

#145
post #14

Earlier quoted context omitted.

I'm physically dependent on caffeine. Why bother fixing that when it is cheap legal and available?

No you aren't. Caffeine "withdrawals" are trivial and not life threatening at all.

Opiate withdrawal is generally not life threatening either.

Re: What Science Says to Do If Your Loved One Has an Opioid Addiction

#146
post #135

I read this, as a recovering addict that went through my own hell mostly from alcoholism, and wondered where the "science" part was? For instance this sentence "More than 13 percent of its participants died after treatment,1 mainly of overdoses that could potentially have been prevented with evidence-based care." The argument is that they "could" have been prevented but how do they really know that? How many people i…

> In the U.K., researchers looked at data from more than 150,000 people treated for opioid addiction from 2005 to 2009 and found that those on buprenorphine or methadone had half the death rate compared with those who engaged in any type of abstinence-oriented treatment. That's some pretty scary data. Half the death rate... that's a very significant number. > You're advocating to stay on a drug the rest of your life?…

If there were 0 people who recovered from opiate addiction without being hooked on a maintenance drug for the rest of their lives then it'd have more credence. If you give an alcoholic xanax for the rest of their life because it affects the same area of the brain but they aren't drunk anymore, are they recovered?

Not to mention, that seems like a pretty horrible and bleak outlook to make people believe they can't make a full recovery without being medicated for the rest of their life.

Again, I've known many people who have taken these drugs and a large number of them relapse bad. In fact, from what I hear the withdrawl from suboxone is 10x worse than from heroin.

Re: What Science Says to Do If Your Loved One Has an Opioid Addiction

#147
post #130

I read this, as a recovering addict that went through my own hell mostly from alcoholism, and wondered where the "science" part was? For instance this sentence "More than 13 percent of its participants died after treatment,1 mainly of overdoses that could potentially have been prevented with evidence-based care." The argument is that they "could" have been prevented but how do they really know that? How many people i…

Alcohol != opioid. As I said in another comment, alcohol is an odd drug. It's mechanisms work very differently from opioids and needs very different behaviors and strategies to combat.

In my opinion you can't simply discard the debate as comparing apples to oranges... There are many similarities. It's a drug addiction at the end of the day.

Re: What Science Says to Do If Your Loved One Has an Opioid Addiction

#148
post #123

Earlier quoted context omitted.

The prison system is highly privatized. Prisons with more people in them make more money and have a higher return on investment. Prisons that have repeat visitors can out compete prisons that do not. Therefore, there is a selection towards not keeping an inmate out of prison in the future. I hate how tinfoil hat-y this sounds, and I'm certainly no expert, so feel free to offer alternatives

The ACLU, using from the Bureau of Justice Statistics, says that "for-profit companies were responsible for approximately 7 percent of state prisoners and 18 percent of federal prisoners in 2015" I don't think that count's as "highly" privatized. I personally think the incentives involved in the private prison system present major ethical issues, but I think we need to look at the incentives involved with the our leg…

They may be referring to a bit more than that. Most inmate supplies, from clothing to blankets to mattresses to hygiene supplies, comes from one company called Bob Barker - no affiliation with the TV personality. There are just a few companies that supply canteen/commissary services. Construction is done by just a few companies.

Things like that may be what they are referring to.

Re: What Science Says to Do If Your Loved One Has an Opioid Addiction

#149
post #135

Earlier quoted context omitted.

> In the U.K., researchers looked at data from more than 150,000 people treated for opioid addiction from 2005 to 2009 and found that those on buprenorphine or methadone had half the death rate compared with those who engaged in any type of abstinence-oriented treatment. That's some pretty scary data. Half the death rate... that's a very significant number. > You're advocating to stay on a drug the rest of your life?…

If there were 0 people who recovered from opiate addiction without being hooked on a maintenance drug for the rest of their lives then it'd have more credence. If you give an alcoholic xanax for the rest of their life because it affects the same area of the brain but they aren't drunk anymore, are they recovered? Not to mention, that seems like a pretty horrible and bleak outlook to make people believe they can't mak…

It's not always about recovery, but harm reduction.

Re: What Science Says to Do If Your Loved One Has an Opioid Addiction

#150

OP here. An interesting takeaway I had was the importance of community. Does anyone know any non-profits or startups working to increase people's sense of community at a mass scale? It seems this is missing from large parts of the western world and has many consequences.

I've seen a couple of documentaries where KKK members were interviewed and the sense of purpose and community seemed to be the main thing they were all getting out of it.

I'm not saying the KKK is a good community group, but I will say there are a lot of people with less community than they offer.

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