perjantai 15. heinäkuuta 2016

Part 13: Thoughts on harm creation

Lately, I've been watching some very interesting lectures on the underlying factors that lead to and exasperate behaviours to such a degree, that they get defined as diseases or disorders under the umbrella of addiction.
Two basic premises came up that were suggested to lie at the core of pathological addictive behaviour:

Structural chages in the brain reward circuitry:
A process involving hypersensitization of the dopamine release process, that leads to overactivative reward pathways (and the physical tolerance-withdrawal cycle) and at the same time loss of activity in the regions that reguate things like impulse control. It has been suggested that the brain scans of these two regions is a reliable way of testing for the presence of addiction. This is kind of a potential objective measure which could be used, unfortunately it seems quite hard to implement on a larger scale, so the prevalence of subjective measures based on mostly frequency of use persist. But it does have some very interesting implications in comparing for instance different nicotine products and their effects on the functionality of the brain.

Chronic dysphoria:
Dysphoria refers to a sort of feeling of social unease, restlessness and is a source of fairly high stress. Others spell this out in with examples, like lack and dysfunctional social connections. It has been long established that functional social networks and relationships are a great resource for not only relapse prevention and helping people with problematic use, but protective against susceptibility for the development of problems in the first place. Dysphoria also seems to exasperate existing problems, due to an increased need to "self-medicate".

The concepts around dysphoria are a great interest to me, and I've touched on similar things in this blog in the past on some thoughts on "creating" addicts by conjuring a problem out of thin air in people that do not actually have addictive behaviour. What I got to thinking during the lectures is somewhat along the same lines of that, but involving the people that are actually addicted.
It seems clear, that if dysphoria is a driving factor in problematic use, then the de-normalization efforts of shame and stigma in reality are not just immoral. They are extremely counter-productive, possibly making the existing problems much worse. 
Potentially so much worse, that it's entirely possible the intentionally created social discomfort and anxiety is potentially acting as a cause of moving to more dangerous, even deadly behaviours AND making them worse.
A self-fulfilling profecy if you will, as low risk product use is generally opposed on the back of this effect happening caused by the product use itself.

A core rule of any policy and regulation measures is (or should be), that the action is weighed against inaction and trying to analyze which option is actually beneficial.
This, simply does not exist in the field of tobacco control. They seem to want any and all possible restrictions they can possibly think of, regardless of the consequences. And if the stick doesn't work, get a bigger stick with more pointy things on it.

it's a steep hill to climb, but I do hope we can get to a point, where people can be treated as human beings again.
As for THR-product use.. My hypothesis so far is that for instance vaping should likely have a fairly radical difference to smoking in the measures for both the addiction inventory questionnaires (excluding things like FTND, which is useless for vaping) but also in the decreases and increases of brain activity potentially associated with addiction.

I would love to see that study!

Maybe then we could see some of the intentional creation of dysphoria fade away and start being rational about nicotine use in a wider scale, not just the echo chambers of advocates.

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