This is interesting, and confirms what I understand about heroin addiction. This is why harm reduction is such a good policy - addicts aren't sitting around waiting for something external to appear and help them quit heroin, if they want to quit they will generally go ahead and seek out the means to do so. Until then, making sure there is a supply of clean needles etc. is the best option, while making sure facilities and medication is available to help those who have decided to fix the problem.

Or you can try to fix the problem, with drug laws that are actually enforced.

You can say addicts are irreversibly damaged, but there is little excuse for the authorities to sit idle while new people become addicted.

This simply doesn't work. There is no level of enforcement which can make it impossible to obtain drugs, merely very difficult. Even in overtly totalitarian countries.

Drugs are available even in prisons.

Singapore is clean, other countries don't have a growing opiate problem.

Singapore is clean because anyone possessing more than tiny bit of any illegal drug automatically gets the death penalty.

We can look at countries that have fierce, well enforced drug laws and see that even they have problems with addiction.

If the aim is to reduce harm to addicts, and the people around addicts, and the victims of crime perpetrated by addicts then authorities need to start treating addiction as a public health problem, with support from criminal justice around acquisitive crime.

Treating addiction as a criminal justice problem clearly, unambiguously, does not work.

Absolutely, and this is why I talked about harm reduction as a drug policy in my parent comment. The thing about addicts is that they will do anything to get their next hit - someone who does not have a heroin habit just has no idea of the strength of the drive to obtain more. As mentioned, drugs are available in prisons. One thing that would make most addict's lives easier and less chaotic would be the ability to obtain their drug of choice without fear of prison; essentially decriminalisation of personal use quantities. I don't think we're ready for legalisation, or prescription of drugs, but it is not considered a bad thing by most drug treatment professionals.

Why doesn't it work? One argument is to say it hasn't historical worked well in the USA, but it might be interesting to actually figure out the reason .

In other places it has for example opiate use in China is 5x less than in the US.

Have you got data that supports the 5x difference of opiate use being solely a criminal justice victory?

Seems like there are many reasons why that might be true.

19th century China was synonymous with opiate use, then they shot everybody. I'm not sure this is the approach America should take, but I am consistent shocked by the wide availability of hard drugs in the USA - and frankly a culture that tolerate their use.

And how is that working out so far?

Exactly! Current enforcement has been terrible, we should fix that.

Not just that, but AA is tailored around a certain personality type. There's a certain type of personality, certain type of big ego, that left to its own devices will always justify itself. We all are rationalizers, but these are the kings of rationalization, and also bullshit. What AA does for these people is provide them with a community of fellow bullshitters who see right through all their bullshit and will call them on it. The whole disease label is first and foremost a way of framing the social function of the group, the actual epidemiological subtleties of what constitutes a disease is really neither her nor there.

What I find irritating about these scientists crusading for "real science" and denouncing AA is that not a one of them would have the first clue how to get through to this type of alcoholic personality. All their ivory tower rhetoric just washes right off their back.

I wasn't sure if you're advocating for or against AA but it all boils down to it being a support system of one addict/alcoholic speaking (getting through) to another. That being said I disagree that there is "a certain type of big ego". Sorry but that is just simply not the case from my own personal experience. There are literally millions of people that walk through the doors of AA and other 12 step programs from all walks of life, all types of personalities and a high variance of ego. It is the last stop on the block...

For. Let me try to clarify, I'm not saying that everyone who goes to AA, or even everyone that AA helps is one personality type. Also when I say "big ego" I don't necessarily mean an externally facing ego in the popular sense, but rather the way the person relates to themselves and how they justify things in their own mind.

What I'm saying is AA is uniquely suited to this personality type in a way that no other program is.

This is a good point, I never thought of it this way before. Then again, that doesn't necessarily mean it isn't a disease.

However I've started to come to think of addiction notice a disease onto itself, but as a symptom of some other underlying "dis-ease", clinical or otherwise.

If anything, the debate over whether addiction is a disease underscores the fact that the people having the debate have a very narrow definition of "disease". If addiction isn't disease, then what is it?

I went through an addiction myself and I agree with you.

Emotions are not super well understood, and I think they are at the root of addiction. If you are chronically unhappy, drugs let you feel good. You start feeling better because of the drugs, and lose the ability to respond to negative emotion in a healthy way. Healthy emotional balance lets people make good choices and fix bad problems. Being chronically unhappy - perhaps as a result of unresolved mental injury - will hamper a persons ability to make good choices, just like being keep in darkness for a log time will make your eyes way too sensitive to handle normal light.

Show me someone who is addicted to drugs, and I'll show you someone who is unhappy about something other than the drugs. The addiction just makes the underlying problem worse.

If you can learn to fix the underlying problem, then fixing the addiction itself is much easier.

Once you are knee deep in drugs, your life becomes awful which gives you more reason to keep using the drugs. It's like a local minimum, or an AI that learns to manipulate it's model of the world, because that's easier than manipulating the world itself.

I have similar beliefs (preference to a theory that appears to make sense to me, but which I cannot readily find supportive scientific evidence for or against).

I suspect that actually curing addiction, or many other mental diseases, will require not just changes within, but also changes externally.

The sooner society can rid it's self of the blame culture, and adopt the more pragmatic 'solve the problems' culture, the better.

And I guess this comes full circle back to the 12 Steps: powerlessness is one way to achieve blamelessness

> This is a good point, I never thought of it this way before. Then again, that doesn't necessarily mean it isn't a disease.

One could argue, all that means is that "it" is addiction that one can't manage on one's own.