Heroin addicts often seem normal
justismills.substack.com146 points by surprisetalk a day ago
146 points by surprisetalk a day ago
This is an important topic, because people spend time and money pushing for social policies based on their belief that all opioid users are the homeless, dysfunctional people they see living on the street. Washington state has had republicans pushing for laws that would allow CPS to remove kids from a parent based entirely on the information that the parent uses illegal opioids [0]. If you think all of those parents are living in tents and motels and begging for food while spending the day high, this might sound reasonable. Putting kids in foster care is better than letting them die, is the argument.
But it isn’t reasonable, partly because there are so many opioid addicts that don’t show up in measures of homelessness etc. These laws would involve putting 10,000 kids into foster care so that maybe 10 deaths are prevented - and this would overwhelm the foster system entirely, tripling the size in an instant, so you’d almost certainly see ten children die because they were put into the system.
[0] As an example of the level of thought and knowledge going into these attempts, one legislator wrote a bill that said any opioid use meant CPS should remove your child. Don’t know if they didn’t know it could be a prescribed medication or what.
I would assume CPS in the context of drug addicts are not just worried about basic living conditions, but also about neglect by the parents.
I would be worried about the child of an alcohol addict, let alone an opioid addict.
But this is just an assumption; I don't actually know of any statistics correlating addiction with neglect.
CPS doesn’t draw a distinction between living conditions and neglect. They are only supposed to look for neglect and abuse, including placing children in unsafe situations. Their guidance documents are full of statements like “it is not neglect for children to share a bedroom.”
I would wonder though how many opioid addicts are more addicted for literal pain relief reasons, to give a bad comparison someone like House on the TV show. In that case I could see it working out fine, that's much more like buying pain medication illegally because you can't afford or can't see a doctor for some reason.
Remember dukie from the wire. He would be one such example. Functional parents, addicts, but functional. Not living on the streets.
Why use fictional examples when JD Vance's own mother is one such case.
Is she? When JD proposed to his wife, his wife made it clear that she was opposed to JD's mother's ever having unsupervised time with the children they planned to have. (Source: JD's interview with Rogan right before the election.)
Although she dropped her opposition years later after his mother improved, I still wouldn't hold his mother out as an example of a functional addict.
(Also when he was a child, didn't his mother send him to live with his grandparents because she was too dysfunctional to care for him? Or did I get that wrong?)
I wonder if they would've felt the same if his mother was predisposed to having too many glasses of wine with dinner. It feels like a third of Boomer couples I know are functional alcoholics. Way too much enthusiasm for wine, wineries, wine tasting, etc. for it to be healthy.
That proposal is meant to punish the parents and make it easier to take kids off non-addicts that dont conform to this and that. It would just be a question of time till they try to extend it to weed or whatever they associate with hated groups.
It is not like republicans would care what happens with kids themselves. If they get harmed by foster system (which they will) that will just allow them to cut fundings to foster system.
Yeah 100%. CPS has in their manuals repeated the phrase “it is not considered neglect for a family to be poor.” That suggests they’ve been weaponized often against “people we don’t like.”
The other thing of note is that that same group of people are more interested in fostering and adopting and that it’s also a way to indoctrinate the children of “people we don’t like.”
just stop all the programs, let the parents self-medicate, and let the kids do what they will. the problem will be solved in 12 months if the governments stays out of it. any solution has a cost in lost lives. some solutions don't keep killing people year after year.
Article should be titled “Heroin Addicts Who Can Afford To Support Their Habit Often Seem Normal.”
His roommate’s klepto friend sure seemed abnormal.
Also, my understanding from folk who do use is that heroin doesn’t exist in meaningful quantity in today’s market. It’s all fent. Even the stuff that claims to be h is cut with fent, and maybe xylazine if you are especially unlucky.
This is actually why I think all recreational drugs should be legal. I know of approximately 0 people who have had the thought “I’d try heroin if it were legal”. All making it illegal does is make the supply deadly.
I truly believe that there would be fewer addicts and fewer overdoses if you could buy regulated heroin.
I actually think more people would use if it were legal. Maybe not immediately but over time it would become more normalized. Regular joe character in tv shows would just use heroine. It would be available at college parties next to kegs. Etc…. And heroine companies (now that it’s legal) would find ways to market their drugs even if direct advertising isn’t legal.
I don’t think that’s true of heroin to a large extent, but I do think it would be true of cocaine, psychedelics, and other drugs. But regardless, I think the overall effect would be net harm mitigation given all the downsides of making it illegal. Funding violent crime at home and abroad, stigmatizing it and deterring treatment, overdoses from unsafe supply, etc. It’s entirely possible that more people would use it and it would still result in less harm to society.
I've been saying the same thing for years. Everything should be legal, prohibition just causes more problems. We learned this lesson with alcohol already.
Making it legal we could have things sold over the counter in pharmacies with proper age checks, we could even require further checks like before you can purchase heroin you need to go through a process where it is explained how it works, what a reasonable dose is, what side effects are, how addictive it is etc.
Same with other stuff. Most drugs are quite safe and harmless if done by people who know what they're doing. Of course self destructive people and morons would still harm themselves but honestly I'm not too worried about that. They will always find ways to harm themselves.
At least drug users wouldn't be funding cartels and warlords etc.
Go to the QuittingKratom subreddit and see for yourself how a legal opioid-like substance destroys lives.
Sure. Alcohol does too. We made it illegal, it only worsened problems.
It’s a balance sheet and you can’t just look at the debits and not the credits.
I already addressed this. Drugs are currently illegal and yet millions of people are destroying their lives with drugs right now. So clearly, prohibition does not solve this problem. I could buy heroin right now, on a a Sunday when most stores are closed in my country, within an hour. The only difference is I wouldn't know if it was cut with fentanyl and other adulterants, they wouldn't care about selling to youth, etc.
But the post you're replying to is about a legal substance, so that doesn't seem relevant.
Kratom definitely isn't legal where I live. And either way I don't see your point. I said things should be legal because prohibition only causes more harm - they said this legal thing causes harm - I said that does not disprove my point.
Prohibition does not stop the sale, use and abuse of substances. This is indisputable. The question then is whether or not legalization actually reduces the harm caused by these substances. I believe it does. Both by weakening the black market, ensuring people actually get what they think they're buying rather than whatever the dealer happens to give them, controlling who can purchase things, providing opportunities to educate people before they are able to purchase etc.
All these things are already widely and easily available. Legalization doesn't really change anything in that regard. And most illegal drugs aren't as bad as people are led to believe either. Most of them can be used responsibly with hardly any negative effects, certainly no more than alcohol. The worst part about them is that we don't know what we're getting. We don't know the concentration and we don't even know whether it is what we think it is at all.
There's also the tax revenue we would collect from the legal sale of drugs which could be used to provide education and help those who are struggling.
I used to think like this. But lets take a different addictive habit that recently became legal. People were able to gamble pre-legalization, but hardly anyone I knew was addicted to illegal sports betting. Now that it is legal, I would say large amount of friends show very addicted looking behavior around it.
There is a reason why heroine used to be sold as cough syrup and over time became illegal. I know we want to say the war on drugs was all a war on minorities (and with pot it was), but have you looked into the history of people turning into junkies?
It can be legal and tightly controlled at the same time. Here in my European country it's perfectly legal to prescribe opiates but after 3rd prescription (regardless of what opiate it was) a patient has to go for mandatory psychiatric evaluation. This has put potential opiate abuser on the radar in a meaningful way. Legalisation doesn't mean free for all just like alcohol.
The US literally just tried that with gambling, and we discovered that making gambling legal increased the number of addicts by so much that it shows up in "total bankruptcies" statistics.
The key difference is people view heroin as something that will ruin your life, but think gambling is a harmless pass time until it is too late. There’s nobody who doesn’t know the perils of heroin, legal gambling existed in most places in some form and had for a long time. People view it much more like alcohol than heroin.
Also we didn’t just try that with gambling (48 states have had some legal form of it forever) we just tried it with online sports books, which turn out to be a particularly virulent form of gambling. And we haven’t really begun to sensibly regulate that, a lot of harm may be reduced in the near future as we do.
> The key difference is people view heroin as something that will ruin your life,
Now they do; make it legal and in two generations it won't be viewed that way because, after all, it's legal!
It's worth noting that there's a form of gambling that's exactly the same as sports betting that has been legal for much longer, the financial markets.
Do you expect the same amount of ads for heroin as for sport betting?
Get your first dose for free! Refer a friend and get more free shots! Every tenth shot for free!
Yes, I do. Heroin was widely advertised before it was banned, and I don’t see why those same commercial pressures wouldn’t lead to it being advertised now if it were legal. It’s not even a lie to say that it works as a cough suppressant!
Weed is legal in many places, are there ads everywhere there?
Also Coca-Cola should be allowed to use a real coke extract. I doubt they will as they cannot even use a real sugar in USA anymore.
We also made it extremely easy to gamble. It'd be the equivalent to handing everyone a heroin replicator, so that all people had to do was press a button and heroin would instantly appear.
Isnt that more because gambling is ingrained with American culture? It’s seems to be pretty much everywhere.
Gambling as in roulette, gambling as in games of skill, or gambling as in trading?
In the last case gambling is pretty much everywhere in all developed societies.
> gambling as in games of skill,
These are pure gamblimg, the skill part is thinly weiled excuse having little to do with the reality. Even if it was skilled, it would still be gambling, but for the most part it is not skilled.
> or gambling as in trading?
Yeah many small investors treat it as a pure gambling. But investing has more regulations and somewhat saner culture. The companies are not intentionally trying to identify and hook addicts deeper and deeper.
Which "sports" literally do.
One data point, I live in East Asia, it’s very illegal, and vanishingly few people have drug problems (often they substitute for other problems that are less illegal, like gambling or sex).
Well, that’s really nice, and I don’t know how you pull that off, but it doesn’t translate to western societies. It’s very illegal most places, but how much of a problem it is seems to vary by region.
It doesn't translate because you don't get the death penalty for having 1g of Cannabis
I moved to Asia from London / NY.
I found this draconian policy jarring at first (never a drug user, but casual cocaine / pot use was everywhere in both London and NY, and the usual cocktail of whatever was fashionable too).
You get used to these policies pretty quickly, and in exchange there are no (visible) drug users and no (visible) homelessness; I don't think in the West we are willing to sacrifice the freedom to do these things, or impose the death penalty for importing drugs (we have abolished it for nearly every other crime apart from murder in most jurisdictions).
I say that not making a value judgement (I cherish and in some cases miss western freedoms, and believe we do all too little to defend them at home), rather observing from nearly 40 years in western society and <12 months in the East.
It's worth remembering that much of Asia went through terrible drug addiction epidemics in the 20th century [0], and they decided to take drastic action, which probably took 25 years to fully bear fruit.
I also don't believe this policy, in isolation, is the whole answer. Asia (and particularly Singapore) focuses on society, community and other values which attenuate the factors which lead to, and are exacerbated by, drug use (violence, theft, vagrancy, unemployment, under-employment).
You give up a lot of freedom, but you get order in return. For some of us, that is acceptable. For others, this is not (and that is ultimately a matter for voters in each polity).
[0] https://www.unodc.org/unodc/en/data-and-analysis/bulletin/bu...
It doesn’t translate to western societies because the vast majority of western societies thinks the death penalty is unacceptable at all. And getting the death penalty for drug possession no mater the scale is absolutely insane.
Well Singapore for example ain't democracy in western sense at all. Rather some longer-term benevolent dictatorship with some smart (and lucky) moves. Canning for what we definitely dont call severe crimes in the west, executing mentally disabled people manipulated into drug smuggling and so on.
Its also a society openly xenophobic for immigration to any ethnicity not being part of original mix of population (not race, not language but properly ethnicity, ie tamils from south india big NO, malay tamils YES). White westerners not welcomed, only toleracted for specific set of high flying positions, and only for specific time while they keep economy running.
Its a very interesting place to observe some sort of south east asian version of Switzerland (sans most freedoms), but there are hardly any lessons for the west. Sort of like what ideal China could be, but probably never will. If you want to see proper western-possible high point, that Switzerland IMHO is top spot. They have some drug addicts, but have rather sensible approach to them.
Yes, if you execute everyone who takes drugs, you won't have many drug users, but that creates a worse problem that you are executing people for taking drugs.
It's certainly true and in civilized countries (like the Swiss I think) the state offers the possibility to have your drugs screened and you can get clean syringes. Makes so much more sense than to criminialize addicted humans.
In Switzerland, at the appropriate facilities, the state provides heroin to addicts.
This has a dual effect - addicts get clean drugs and take them under medical supervision, reducing deaths, helping funnel some towards programs that will eventually get them clean etc. With this sort of support it turns out that people no longer steal to get their fix either, and can usually even hold down employment pretty well.
But also the young folk get to see these tired, worn out, older people queuing outside the clinic in the morning to get their fix and realise hey, maybe that isn't so cool and edgy after all...
Seems like a good plan to me, the problem is (as ever) puritans and their politicians, it's an easy thing to screech about. All it would take to kill it dead in a lot of countries would be someone standing up to shout "The opposition party want to spend YOUR tax money giving DRUGS to filthy JUNKIES!"
> I know of approximately 0 people who have had the thought “I’d try heroin if it were legal”.
Perhaps it's because they weren't experiencing enough pain at the time. I think most people fall into drugs circumstantially, I'm not sure it often presents as a conscious lifestyle decision.
> I truly believe that there would be fewer addicts and fewer overdoses if you could buy regulated heroin.
I believe that there would be less drug use overall if our economic system wasn't as rapacious as it currently is.
> I know of approximately 0 people who have had the thought “I’d try heroin if it were legal”.
How many people do you approximately know of that have had the thought “I’d try heroin”?
> I truly believe that there would be fewer addicts and fewer overdoses if you could buy regulated heroin.
How many people do you approximately know of that have had the thought “I’d try heroin but only because I cannot buy regulated heroin”?
Also... isn't the whole opioid addiction crisis basically because people were in fact buying regulated ~heroin?
A lot of people in the early OOs got addicted to pills because doctors subscribed them liberally and they weren’t regulated that well in hospitals so medical staff who wanted to make an extra buck could easily steal and sell them. The government cracked down on this and then all of the pill poppers turned to heroin, which now is mostly fent.
If we're gonna start factoring how well regulated something is, then sure, as long as there's a problem, something's not "regulated."
Lol yes opiate addictions of all stripes for all time can be tied directly back to that oxycontin commercial from 1999
But is the reverse true? Do you know people who thought “I will try heroin because it is illegal”?
That's a very libertarian viewpoint of which I've always tended to agree with, drugs should be legal no matter the circumstances. I remember coming to this forum in the early days of Bitcoin which is also favored by libertarians, I wonder what the majority political viewpoint of HN is. Seems like it would skew toward the libertarian viewpoints of socioeconomics and public policy
if anything it being legal would make it less cool
IME most people dont want to be addicted, theyre just in a rut or life took them a certain way and just need support to get through the other side.
People who dont use drugs are way to hysterical about drug use though to ever see real improvement.
Drugs Now Legal If User Is Employed
https://theonion.com/drugs-now-legal-if-user-is-employed-181...
I grew up in rural nowhere, and so, so many of my HS peers ended up as addicts. From my observation, I'd usually group the addicts in two types: Those predisposition to addiction, often combined with deeply traumatic events in life, and those that get addicted by accident or just with time.
The first group were the visible ones. The kids that came from broken homes, and had experienced abuse or similar traumatic events. They'd start acting out young, be introduced to alcohol, weed, and pills at age 12-15. By the time they were 18, they'd be full-blown addicts to anything the could get their hands on. Since they had no income, they'd supply their drug use by crime. Burglaries, robberies, theft, scams, everything. Eventually they'd move away, and become homeless junkies in a larger town - or extremely rarely, they'd become sober.
The other group of people, those that became addicts by accident or just over time, would be "stealth" addicts - at least until it all boiled over. Some of these people would become addicts after injuries/operations and serious painkillers. Others would escalate their weekend drinking to trying various drugs, and then become weekend users. Until it spilled over to their weekdays. Some could quit/become sober. Others could stick to weekend usage, and many would just slowly circle their drain.
How "functional" one can be, really depends on whether you have the means to support your habit, and how it affects your work + private life. You only need to be caught once, really.
With heroin, your biggest risk is that there's really not many dealers that are pushing heroin. And if you're a full-blown addict, you likely won't say no to whatever replacement they're selling. That's the time old slipper slope:
Become addicted to oxys after surgery or injury -> purchase oxy from dealers when your prescription is used up -> start shooting whatever junk the dealers are selling -> OD
I was an “alcoholic” for many years. It ruined my life and alienated me from many people I love.
Then I met a wonderful woman who wouldn’t give up on me. We went to the doctor over and over again until I was diagnosed with dystonia, a disease which alcohol relieves the painful symptoms of. Once I knew that I wasn’t simply cured, but I had the hope and the knowledge to see though my pain.
Many other drugs are the same way. It’s easier to get these classes of drug illegally rather than legally. People who do these drugs know there’s something wrong with them, but they remain defiant and strong in the face of a society projecting its own decadence onto them.
If you do drugs or alcohol and you know it hurts you and want to stop, there is always hope for you as long as you can accept help. I know from experience.
And to all you who need drugs, but reject a diagnosis. As Big L said “If that’s what you need to maintain, go ahead and do your thang.”
This.
Most people do drugs or alcohol for kicks or to put the pain away, as in general, but there are a lot of people who are self medicating symptoms they are well aware and they know this "medicine" works for them.
Breaking out of that habit is extremly hard.
At the beginning of covid I found myself in a really dark place and opted to seek help with psychotherapy.
I had a long story of health and legal issues and I often told my peers that second opinion is key, no one is omnipotent and with hard legal or medical case it's worth seeking out opinion of at least two professionals (and if their opinions are contradicting - keep seeking).
I met eleven certified experts.
At the beginning of my journey one of them, guy with stellar reviews, upon hearing that I haven't been properly diagnosed, but I suspect I might be on the spectrum looked at me and said "no... I'm looking at you look perfectly healthy". One after five sessions when I said I'm not getting any feedback, like anything, I was the only one talking during the sessions, told me it take years to get to the core.
Long story short - just before someone advertise as an expert doesn't mean they know anything, or they care. Even in highly regulated circuit.
I saw many therapists and I have pretty mixed feelings about it. I honestly it did a lot for me when a therapist simply said “Wow that’s a bad situation I feel really bad for you. It so unfair.”
But anytime I looked for instructions or objectives on how to improve my life they would basically say “I can’t tell you exactly what to do, you need to come to that conclusion for yourself.” The problem was I genuinely didn’t know what to do. They always tried to see things from my side, but never really believed that spending my night in a drunken stupor watching TV until I passed out was actually contributing to my happiness more than being in agony every night slowly building my contempt for humanity. Even though it’s against their training, they can’t help but judge you lifestyle and unusually that manifests as silence on important issues instead of disagreement.
> The problem was I genuinely didn’t know what to do.
That is the problem, yes.
I think a lot of the confusion from people just beginning their psychotherapeutic journey is that they think the point of therapy is to make them happier. No. The point of therapy is to make them happier, and sadder, and angrier, and more driven, and aware of their fear, and connected to their shame and guilt, and able to love. In short, it's to give you perspective on emotions, so that you can feel them on a minute-to-minute basis and decide what you want to do, and realize that "because you want to do it" is just as valid as any other reason, if not more.
> spending my night in a drunken stupor watching TV until I passed out was actually contributing to my happiness more than being in agony every night slowly building my contempt for humanity
A therapist would be naturally conflicted about this, because spending your night in a drunker stupor watching TV will make you happier, but being in agony every night slowly building your contempt for humanity is the work that needs to be done. The point of therapy is to help your understand a.) that you are in agony every night and b.) why are you building your contempt for humanity? It's to help you feel the emotions, and to feel them as emotions, and then to eventually integrate them into your life in a way that is constructive.
Your comment reminded me of this: https://m.youtube.com/watch?v=Bx2JA8KzV3s
> But anytime I looked for instructions or objectives on how to improve my life they would basically say “I can’t tell you exactly what to do, you need to come to that conclusion for yourself.”
It comes down to this. I can meet and talk with you and pronounce judgement on your life, but me telling you what to do isn't the same as you figuring it out for yourself. You have to do that hard work. you have to sit there until you're past bored and reflect on the things you've done. and it sucks, and it's boring, and why can't you just give me the answer. But human psychology is what it is. me telling you just isn't going to be internalized the same way. One external entity has has better questions that others. some of the deepest and best insights have come from random strangers I don't know and have little connection to, in random and serendipitous moments. Watching TV, your not going up find that, imo. you've got to go out there to find yourself, as hokey as that sounds.
> told me it take years to get to the core.
So FWIW, that part is true. I started therapy in 2012. I got to the core in 2020, after going through 4 different therapists. Along the way I founded about 15 startups, missed out on roughly $2M in lost wages, almost divorced my wife and walked out on my kid, thought seriously about killing myself, and needed a global pandemic to finally get my life in order. But I did eventually get my life back. And I didn't even get involved with any drugs or chemical dependencies; video games were my worst addiction.
The reason it takes so long is because a therapist will never tell you the problem, they need you to experience it for yourself. That is part of the point. As one of the better therapists I saw (the last one, actually, the one that got me through the breakthrough) said: "One of the ways to make feelings go away is to, well, feel them." Until your brain has the capacity to distinguish your feelings from existence, separate them out, and then push through some often very unpleasant, potentially life-ending feelings and actually feel them, you'll usually tend to end up deflecting or coping with them.
Much of the process of therapy involves stripping away these coping mechanisms and seeing what the feelings are beneath them. And that takes years, and has to be done in parallel with your life, because living your life is the point of therapy. That's why my first therapist encouraged me to try getting involved in my first relationship, even though I suspected I would end up hurt by it. (I ended up marrying and having three kids with her - the youngest is currently sleeping with his foot draped over me. And yes, I gave up nearly all my dreams and everything I thought was my identity for her.) That's why my therapist encouraged me to quit my highly-paid but soul-sucking FANG job to follow my startup dreams. Until you're actually in those situations, where you are risking your ego and living with vulnerability, you're not in a position to process the feelings that arise from them.
Possibly the best advice I got - from a random stranger on Reddit, not a therapist - was to think of your therapist as a guide, not a fixer or even an expert. You do the work of figuring out yourself, and it takes years, perhaps a lifetime. The therapist is there to make sure you don't hurt yourself and to keep the focus on your real issues, because when it comes to unpleasant feelings, the natural inclination is to avoid them. It almost doesn't matter if they're any good, as long as they adhere to a basic code of ethics and professional conduct, because all of the heavy lifting and all the major discoveries are made by you yourself.
Took me four years to "graduate" therapy (showing up happy to every session and my therapist asking me "why are you still coming in?") and I agree with every word you wrote here.
With that said, those first few months were not just my therapist being "a guide" through the life I was living. There were parts of my history that I didn't realize I needed to cry about and forgive myself over, before I could even try to go through life without that chip on my shoulder.
> almost doesn't matter if they're any good
It's very difficult to rate therapists, because there's both an empirical (their training and experience) and subjective (do you feel comfortable with them?) component. A therapist can be incredibly smart and talented and will be the absolute wrong fit for a patient who doesn't feel comfortable with them. And someone else can be not-a-therapist-at-all (i.e. clergy), who the patient feels very comfortable talking to, but those conversations will go nowhere if the patient is never challenged and/or never willing to face the challenges. All anybody can do, really, is just keep trying.
You know why audiophile grade cables takes 900h of burn in? Because that's more than 30 days of return policy.
If you go a therapy and all you get is talking to a wall while you're therapist is skimming through a phone, that's not a progress, that's a scam.
The therapist should at least be engaged in the session and actively listening - if they're just scrolling through their phone, find a different therapist.
But if you've been to 11 therapists and none worked, the problem is probably not all 11 of the therapists.
You have to be at least engaged in the session and actively introspecting too. If you're not curious about where your issues stem from and willing to try some (oftentimes difficult) approaches to dealing with them, the therapist isn't going to be either. They'll happily take your money and give you their time, but there isn't anything to work with to get better.
That’s also a misrepresentation of what happened for many of us when we did therapy though. You have to want to change badly enough that you’re willing to try things. It’s not enough to have a vague sense that there’s something wrong. It has to be crystal clear to you that you need to change somehow.
This is not to try and devalue the nature of your specific experience at all, okay? But, with your and some other descriptions here of how therapy works and how much looking around and trying out a number of vaguely defined things it involves, i'm getting a distinct woo vibe from much of the industry, made, maybe, all the worse given how much more fashionable the idea of therapy has become in recent years and how few concrete standards some parts of the business (and it is a business in large part) really require.
Add to the above the subtle notion of the onus on improvement lying with oneself as the patient, and it becomes all the easier for a therapist to fail because they don't know what they're doing, and then claim their patient failed because they didn't "try hard enough" or do the right things.
I've seen cases of therapy working, and know there's a lot of good exploration in related psychological fields, but it's definitely an area in which to tread carefully as someone seeking help.
There’s no silver bullet. Only a lot of flailing around and unmaking patterns that don’t work and sometimes patterns that did work.
That's fair enough, and common even in medical areas where the hard science and research are far more firmly established. However, with therapy, the looseness of those very things make the field much more open to easier quackery and that's what my point was about.
> told me it take years to get to the
That’s the grift — healing sold as a subscription. The incentive for therapists to behave this way can’t be regulated away because the regulation itself acts as a cover for this behavior: credentials, ethics boards, continuing-ed checkboxes — all window dressing to sanctify creating a dependency in the patient. The system launders manipulation through professionalism and calls it care.
If you want to become fit, you need to exercise indefinitely or your muscles will atrophy. If you want to lose weight, you need to diet indefinitely or you'll regain it. The steps you take to lower your cholesterol? Indefinite. Blood pressure? Indefinite. Blood sugar? Indefinite.
It's no different with mental health. We are perpetual works in progress. Any changes take not only effort to accomplish, but effort to maintain. That's just how humans work.
That's the grift - fitness packaged as subscription. They want you to have to keep exercising to maintain fitness.
The strongest indicator of general mental unwellness is the pervasive religious belief that "you need to work on yourself."
I think most if not all need for drug use would pretty much disappear overnight if we lived in a society where just being human didn't result in excommunication.
In my early 20s I ordered takeout every night and mostly ate like crap, but my health and general wellbeing improved (along with my finances) when I started cooking at home and eating a more balanced diet.
Was there something "wrong" with me? No, but I definitely prefer this version of myself! And it takes sustained, ongoing effort — there are still nights when I'm tempted to just order takeout, but I push myself to cook something and end up glad I did so.
The same goes for physical fitness, career, hobbies, personal relationships, mental health… you can just sort of blindly stumble through life without any intentionality, but to me it seems like a good way to squander your precious years on this planet.
>If you want to become fit, you need to exercise indefinitely or your muscles will atrophy.
You can feel and see the effects of exercise very soon after starting. It's cumulative and predictable. Therapy is nothing like that.
It depends on the therapist and the patient. Therapists, like every other profession has practitioners that are really really good, some that are mediocre, and everything in between. Patients, too, come in all shapes and all sizes.
When therapy works, it works really really well, and relatively quickly too. From casual observation of friends and other people around me (ie, as a regular person; I'm not a health care professional.) I've seen people manage to make sustained healthy changes in just a handful of sessions. I've also seen people not improve, or take far longer.
If you've been going to therapy for more than a few months and haven't been improving, it's time to change something up. Therapy should be "something like that".
I’m not so sure. I think there really are a lot of people who benefit from some kind of talk therapy and that that therapy might actually take a long time to produce results.
You have your whole life to ingrain thoughts, behaviors, and emotional responses into your being. If you anre unlucky, you might be surrounded by other people who reinforce maladaptive ways of thinking and being, such that they seem 100% normal. Expecting those deeply carved neural pathways to change quickly through any intervention is ridiculous.
Think about how cult deprogramming is a specialized skill with a high failure rate. Except this cult only has a single member, your inner monologue. It can take a lot of time for a therapist to figure out what the cult is even about, and it all comes from you talking (and talking and talking…)
Correct. And even if you've identified whatever changes need to be made, that doesn't mean you're ready to quit therapy. Often the required changes are difficult and emotionally challenging!
BTW, I think a lot of the HN cynicism on this subject comes from how psychotherapy is practiced in California specifically. California has a separate licensing system from the rest of the country and doesn't allow eg. teletherapy from therapists in other states. As a result I found that therapists in CA were more expensive, more difficult to access, and significantly lower quality than I've experienced elsewhere. I've heard that regulatory reforms might be on the way though, hopefully that happens.
I think "a lot" is understating it, I would guess that this describes the vast majority of people. It can take years just to find the connection between surface level problems that you see and their root causes. Then once you find the connection it takes a long time time to accept it and even longer to actually heal from it (if ever).
From what I understand, it's generally a lot easier to heal from an acute traumatic event of some sort, no matter how serious it is (e.g. physical or sexual assault), that than it is to heal from sustained and repeated trauma caused by "well-meaning" people.
In the latter case you probably don't even realize that it happened at first because it's an accumulation of a million paper cuts throughout your life. Then if you try to talk to the people involved (e.g. your parents) they'll probably dismiss you and say that you're being dramatic because each instance is utterly insignificant on its own.
You have to peel back so many layers of it until you finally understand what happened, how it affected you, and how to heal from it. And that's just on a cognitive level, on an emotional level which is the one that actually matters it's going to take even longer to internalize everything.
The best thing we could do as a society to solve like half of all of our problems (with everything from unemployment due to personality disorders, to drug use, to violent crime) is to start taking mental well-being seriously, to prevent as much harm as possible and to offer help (for free) at the earliest possible opportunity.
There should be mass public education campaigns about how seemingly subtle and inconsequential things can break people's minds if they're sustained and perpetuated over a long period of time and especially in childhood. And I don't mean those trendy "mental health matters" and "we accept your depression and anxiety <3" campaigns that have been going around for a while because 99.9% of that is completely inauthentic. Even out of the people who claim to care, the vast majority only care long as it's a mild case of it that doesn't actually visibly affect you too much - then the judgement starts.
And the problem is - after a few screw ups I've told myself - hey, maybe you don't know it all, maybe they have some secret formula you don't know about, just take it easy, lay back, don't be a smart ass, and let them take care of you. Be open minded.
I mean, I drove a Mustang in EU, shipped from US before Ford started selling them here. Local Ford didn't even had "mustang" in their system. I kept trolling them when they were offering free service for Ford drivers. My first 6 car mechanics were either a total scam or they were genuine but had absolutely no clue what they were doing.
What was I thinking? Maybe that the trade is regulated, and people with a title are more professional? Hell no.
You probably won't make any progress you if think of therapists like car mechanics, where you give them your broken car and they give you back a fixed one a few days later. Therapists can't just poke around in your brain to find the problems. They certainly can't fix them without your participation.
It's more like working with a physical trainer. You won't accomplish your fitness goals by just showing up. Rather, you need be engaged, learn how to actually use the tools they give you, strive to improve yourself and put in the effort to do so.
Have you even read my post?
I met a gal who kept silent for five visits.
Five paid visits and I got no feedback at all. Silent treatment is what you call it.
And when I finally confronted her about that she told me that I'm making a scene, because normally people are seeing a change only after couple of years.
I'm not defending every therapist in the world, I'm responding to your car mechanic anecdote.
It kind of proves it is a scam. You tried it, it did not work. But for some reason you lived experience is invalid, and you should keep trying again and again!
I know a few people, who import and run vintage american cars in EU. They do all servicing themselves, buy spare parts from american ebay. They totaly think modern car industry is a scam. They would never allow some "professional" mechanic into their beloved car.
> It kind of proves it is a scam. You tried it, it did not work. But for some reason you lived experience is invalid, and you should keep trying again and again!
This is like saying dating is pointless because you dated a half dozen people and didn't end up marrying any of them. (That attitude is also increasingly common these days I've found, maybe because we've all been spoiled by the conveniences provided by the internet and modern consumer capitalism.)
> That’s the grift — healing sold as a subscription.
This therapist might've been, but often problems that require psychotherapy can't be done quickly, no matter how qualified they are and how expediently they're trying to help you. What they said wasn't wrong, but that description certainly makes it sound like they weren't trying to help at all which would've moved that healing timeline from "years" to "never".
Are you saying that psychological issues could be healed quickly if they just tried harder and didn't have the profit motive, or that they don't need to be healed at all?
Yes the lack of a magic bullet is definitely the fault of science.
You can have bad experiences with therapy.
It will put patients off entirely from further therapy.
It sucks if this is you. It really does - because on the flip side, if therapy has worked for you, then you know how your life has improved.
To be devils advocate it was an intersection point between psychotherapy being socially acceptable here in my part of EU and the start of covid where a lot of people reached a breaking point. From a business perspective it's a hunting season and it's not so different from IT where a lot of people game their way in. I was only shocked because I thought it was highly regulated system and on average you should get at least some help.
I am happy it worked for you, but I find this a bit patronising and victim blaming. Not everyone has money, time and health to go to doctors "over and over again". Plus most doctors are just quacks, who throw hypothesis on the wall, to see what sticks.
> as long as you can accept help
What help? Society simple does not care about 49% of people, like at all! There are no shelters for abuse and violence victims, no support groups...
If you speak up or seek help, there is good chance society or abuser retaliates aganst you! You may endup in prison, homeless, or out of job. Or lose your kids!
> but reject a diagnosis
often that means months on strong medication, that makes things much worse. And if that does not work, oopsie, lets "try" another diagnosis. No compensation for the hell, from doctor who caused it, of course!
> most doctors are just quacks, who throw hypothesis on the wall, to see what sticks.
This is the argument that actual quacks leverage to handwave away all of modern science and medicine in favor of whatever vibes-based nonsense they're selling, fyi. Creationists love using this one as well.
Most doctors truly are quacks. They are afraid and greedy.
Rehabilitation efforts would be more successful if not de-incentivized to expel participants for relapsing, i.e., compared to the rest of the world, US rehab programs are soft. Why?
I've spent the first 25 years of my life around addicts of all sorts, you name it, they did it. A short list: smoking, coke, H, alcohol, cannabis, hash etc. Some didn't make it (mostly, the heroin and alcohol addicts, as well as a substantial number of the smokers), some lost their mental faculties (alcohol, cannabis, hash, coke), some kicked their habits (very, very few) and some managed to keep it going for years up to and including today.
I've seen more than I really care for in that sense, including what these substances do to people that once upon a time were nice and functioning adults, both friends and family. If there is anything I'm grateful for it is that they cured me once and for all from even trying any of this stuff. If they were as smart and capable as they seemed and all but a very rare exception ended up much, much worse than they started out (ostracized, poor, extremely ill or dead) then it seemed like a very simple decision not to partake.
And this is where it gets annoying: but the people who do all these things also excel in peer pressure, they'll try anything to get you to join them in their misery. In the end I just came to the conclusion it isn't worth it, and stopped interacting with people that don't have their habits under control. This is also a hard decision but I really don't have the energy.
As the article writes: heroin addicts often seem normal, but that's mostly compared to other people around them, rarely compared to the person that they were before they became addicts, the differences for those cases that I knew were stark and that's before we get into all of the side effects.
Is this really about the impact of drugs on people or about the impact of how drugs users are vilified and ostracized, the impact of living on the streets?
That's just the end stage, and it can take a long time before you get there. And none of these people were 'vilified' unless they gave direct cause for that.
Drug use in and of itself is heavily stigmatized, causing people to be “discarded” and ostracized as deeply ingrained in - for example- USA culture.
Their drug use wasn’t a problem in and of itself until other people decided to treat them differently.
When I say their drug use was a problem, I mean their drug use was a problem. I've known drug uses whose drug use was not a problem but for the majority it really was and it caused me problems in return. Stealing, lying, fights over nothing, psychotic episodes, inability to even make the most basic appointments causing lots of fall-out. Please, I really don't need to be lectured on this.
This is anecdotal but I think heroin, or any drug, addicts often seem normal to those who have never taken drugs or been addicted. I remember my step brother mentioning that my cousin, now dead from an overdose, was high once when he seemed perfectly normal to me.
It’s not necessarily that you’ve done it. It’s that you’ve spent time around addicts. Often these are overlapping life circumstances though..
Once you know the signs, either because you’ve done drugs or been around people who have done a lot of drugs, you see that a lot of people everywhere are high on something.
People always think all opioid addicts are slumped over passed out all the time. And that is usually only when their addiction is really far gone. Early on heroin addicts take moderate doses and keep on functioning. They watch a movie or play video games. You hear people talk about how “clean” the high is, because unlike alcohol they wake up the next day feeling great with no hangover. And they aren’t physically dependent at first, so they think, hey, this is nothing like all of the scary PSAs said it was.
At a certain point one is "maintaining 0". High is "not on the floor writhing or worse."
That said, there can be signs. You may find them normalized from exposure. Or, perhaps: hidden, your cousin maintained appearances. With time and circumstance, everyone slips. Sometimes it's seen.
My (much older) brother managed his addiction, and appearances, well at work for decades. Now clean, thank goodness.
I have my own addictions, and to be honest, I expect everyone to notice and no one ever says anything. Sometimes I wonder if it’s that they don’t notice, or everyone is just too polite, or a mixture of both.
As a good general starting point, assuming other people are broadly similar to you is a pretty good starting point. It helps avoid cartoonish assumptions and provides a fairly good lens for understanding behavior - instead of seeing someone do something and thinking “I would never,” going through the process of figuring out under what conditions you would, in fact, do the thing you’re seeing that other person is doing can be a great way to enrich your understanding of the world.
Between all the coffee, nicotine, CBD, pain killers, psychiatric meds, hormones, nootropics, and micro dosing who’s even normal anymore?
Most of what you mention isn't actually normal for most people. But it is possible to tailor your info feed to make it seem like it's normal.
2/3 of Americans drink coffee. I’ll grant you the rest of the list though.
I was on oxycodone for about 6 weeks for a growth inside my knee. After it was removed, I had to wean off the drugs. Wasn't too bad, took less than a week.
Soon after I thought I'd try to kick the caffeine habit. Went from 4 cups, to 1 over a month, then just green tea, then just water. I only lasted about 6 weeks on water only.
My god. I couldn't believe how unmotivated, soulless, and empty I felt. Judging by the reddit sub for kicking caffeine, this can last for over a year. It's terrifying
When I stopped coffee it was 3 days of being tired and that was it. Which, from what I read, was to be expected normal.
Wow. Can I ask how much you usually drank per day on average?
3 cups every day, sometimes more. A cup was a tee cup size (not a small coffee one) and I made it strong.
Imagine how hard it would be to kick oxy if you were taking it every day for 20 years. Habits and addictions get ingrained with time.
We've also been drinking coffee for a long, long time.
To be pedantic, we've also been prescribing opioids since Ancient Sumer, 8,000 years ago.
Plus it isn't true that we've been drinking coffee for a long, long time.
Wikipedia:
> There is no confirmed evidence, either historical or archaeological, of coffee as a [missing word?] being consumed before the 15th century.
That's more than 600 years. That counts as a long time in my book.
It's basically infinitesimal in comparison to almost everything else we eat or drink.
(Also, an unknown point in the 15th century could be less than 600 years ago.)