This is an incomplete draft for an appendix post I’m working on, I describe the rough idea here, but basically it’s a series of somewhat shorter takes expanding on/responding to my earlier article on alcoholism and talking about addiction more broadly. Part of me is worried about just being known as the EA who overshares about alcoholism, but at the same time the amount of treatment I’m getting now makes it hard for addiction not to be one of the most salient topics on my mind, and because of events that followed it, I feel some guilt with where my original post left off. I will probably cross-post the final post to the forum once I’m finished, both because it will have content relevant to EA as a group and to addiction as a cause area, and because it’s a follow up to a post I cross-posted here already. Not every section will be as relevant however.

Sorry I didn’t put any links in yet (other than the ones in this part), I’ve been working on getting the material ready, and paragraphed so that it wasn’t unreadable. I also plan to add some more sections. Current possible candidates are: a response to Ozy Brennan’s recent post on sex addiction (a rare L in my opinion), my experience with philosophical positions popular within EA that are inconvenient for recovery, some of my broad takes on policy of the form “policy is focused on getting ideal care for the patients they do treat, at the expense of getting as much good care for the overall pool of people who need help”, a review of the basics of some medical options, and discussion of other drugs. I would appreciate any comment feedback on the draft, but also more information/experience with other drugs, especially ketamine and stimulants, and if anyone is really interested in giving thorough feedback, please feel free to reach out about the possibility of scheduling a meeting. Also, worth having a content warning of some kind here, this post gets into some unpleasant territory (though often briefly) - addiction, relapse, self-harm, strained family relationships, unemployment, the works. Especially Appendix A which is also quite personal. Feel free to sit this one out, or at least Appendix A.

Appendix A

In my first blog post I said that I felt I was past the worst of it, and I was optimistic for the future. Unfortunately, I was actually past a particular bad spot, and just before another one. Overall, I never went back to drinking as much as I did in December 2022/January 2023, but the consequences of the drinking I did got worse, my ability to maintain a semi-normal life deteriorated, and I wound up getting much stronger treatment.

I started getting worse at maintaining my Summer plan for sobriety sometime in July, and getting sicker and sicker physically (the suspicion from my symptoms is that I had developed and ulcer/stomach inflammation that was actively bleeding), and eventually decided I needed to spend some time living with my father outside of the city. The exact things that went wrong with this arrangement are complicated and not all of them are mine to tell, but I was drinking quite a lot during this period, and it culminated towards the end of the month with quite destructive behavior, including serious self harm and property damage, as well as lashing out at my family. When I said in my post that you should really appreciate the people around you throughout this…this was only a few months before I failed terribly at this standard.

I eventually agreed to go to rehab, but refused to spend time in a halfway house afterwards because I wanted to keep my job. I wound up relapsing as soon as I got back to the city, and after about a month needed to go to medical detox. I relapsed badly again after this (at this point my health was extremely poor), though I never got back to needing tapering or detox again. I decided after a while of this that I needed to quit my job anyway, and go to a halfway house after all. I will be two months sober as of the 13th, though considering how wrong I was about improving when I wrote the original article, I hesitate to say that I think things are permanently better. I am optimistic, but this is a disease people deal with for decades, and many of them nearly die before successfully quitting (and of course others just die).

That said I am in a safe environment now and trying to find a longer-term safe environment, and I am in an outpatient program and going to groups nearly every night. When I wrote last time, I said that I was hesitant about Tyler Cowen’s teetotalling conclusions…but honestly I don’t think my reasons were very good and my intuitive repulsion from the idea has been worn down over time by worse and worse experiences. So honestly my advice at this point is, just don’t drink. The risk of alcoholism is shocking considering how bad it is and how many people roll that dice. If you do drink be very careful (I have more advice on using in ways that put you at less risk in my appendix on marijuana), but mostly my advice is don’t drink. If it isn’t a huge part of your life, you aren’t giving up much. If it’s such a big part of your life that you feel you are losing something important by stopping, you are probably unusually at risk already.

Appendix B

In my original post, I didn’t discuss recovery groups. I hadn’t been to any other than one my school’s health center runs, but now I’ve been to a ton of meetings. I think meetings like this are generally a good idea, Lorien Psychiatry has a pretty good broad overview on them, but not as thorough an accounting of their differences. There are four big categories I’ve run into. One is just general, unaffiliated. I’ve gone to a bunch of these but they’re harder to find unless you fall into a particular niche or treatment plan that refers you to one (speaking of which, did I mention that I’m trying to start back up one focused on Effective Altruists?) You also have less of an idea of what you’re getting in advance, though even the more affiliated ones have a huge variety in local culture and things that turn different people off or make them feel more at home (much like EA groups).

The three big affiliated groups are Alcoholics Anonymous, Dharma Recovery, and SMART recovery. Out of these, I find SMART recovery to be the best personal fit, and sort of the suspect this will be true for EAs more generally. That said I think AA has some surprising resonances with EA despite its reputation for being the less “rational” of the groups. Scott Alexander (writing as his Scott Siskind persona for the Lorien page) for instance describes them as a bit like a religious cult. Now, part of me reflexively looks at overbroad cult accusations like this and gets quite defensive…but some of the biggest problems I have with AA relative to other groups are things that are either more religious, or more culty than the other groups to some degree.

In terms of cultiness, AA has a sort of self-serving broad approach in a way none of the others have to remotely the same degree. If you go to a SMART or Dharma or unaffiliated meeting, typically there will be much more humility about the program’s effectiveness, and what other things members should try. AA people tend to insist that AA is what works, getting a sponsor is what works, working the steps is what works, sure fine fine you can do the other stuff if you want to, but the actual important thing is always doing AA.

There is also a very shabby epistemology when it comes to justifying their effectiveness. If you claim the 12 steps work, then can’t we just check how often people get sober after working them? Well, obviously many people get sober without AA, but they aren’t speaking at meetings. Many people also fail to get sober after working the steps. Some of them do get sober eventually, and then they will just say they weren’t really working the steps the first time. They weren’t ready, they weren’t serious, they weren’t thorough enough. Of course, when they finally do get sober, obviously that’s when they were doing them right. Others never get sober, but the program concedes that people who aren’t honest with themselves often fail. So someone dies a drunk who tried AA over and over again? Guess they were never self-honest enough.

The 12th step is also a little like this, in that it specifically tells the person doing it to try to get other people to work the program. In order to work all the steps, you need to try to rope other people into them. Obviously it’s more benevolent than this, but it has a slight unsavory MLM taste to it.

The religious element is also a major sticking point, probably the most common one people have. You can just sort of shrug off the self-serving stuff and try out the program, but the issue is working some of the steps requires “God”. Mind you, AA evangelists don’t tend to be too narrow-minded about what you choose for this role, but my impression is still that the alternatives that work in the same way require something with pretty religiony elements, like it being a power that is not you and is greater than you, one that is with you and guiding you in your worst moments, one that you can confess things to and ask things of in a fairly anthropomorphic way, one that cares about you, and one that is strongly related to morality in some way. If you do not believe in something sufficiently like this, it is very hard to get the full program.

The most plausible “higher power” candidates I’ve heard of that soooort of mostly fit these things and which don’t require any spooky religiony beliefs are the AA group itself (the refrain I hear for this one is GOD: Group Of Drunks), or your moral conscience (Good Orderly Direction), but I remain unpersuaded that you get all the same benefits with just one of these. This isn’t something I consider a general problem with the program, none of them will work for everyone, and many people are religious, but my impression is that most EAs are not, which will make it a bit less appealing.

That said, one of the elements that I like most about it is very related to EA, and that is the interest in morality. Many of the steps are in some way focused on reviewing your character flaws and past moral transgressions, and confronting, atoning, and moving past them. I think this is very important, because many addicts find themselves engaging in many behaviors they would, in a different state of mind or earlier in life, considered huge transgressions. And eventually get used to this just being their new normal. This can both be a source of moral injury which leads to broader mental health problems, and something that further erodes someone’s self esteem and prior identity, such that they are no longer as invested in sobriety, feel that drinking is who they now are and that they aren’t worth the huge effort required by them to save.

Heck, I criticized the 12th step earlier, but you can strip it of the AA-centered elements to make it less culty, and then it is just genuinely great advice. One of the best ways to maintain sobriety is to build back up a sense of identity and self esteem through moral service which would be predictably compromised by drinking again. If that identity is built not only on moral good, but also helping others with sobriety, it becomes even more effective, something more new about your identity that doesn’t just try to wipe the slate clean, and something that will be especially compromised if you relapse.

A final advantage of the AA program that I think most people in AA would be somewhat offended by, but which is a genuine strength in my opinion, is the gamification of recovery. You count days, and then say them at the meetings (and eventually months or years instead), and keeping track isn’t just useful for logistics, but also for the part of your lizard brain that gets dopamine from winning “points”. Recovery is also generally a bit of a boring and inactive process by default since the key success criterion is just continuing to not do something (sometimes I have found it useful to really lean into my laziness to avoid drinking too though. “Grooooan, I’m all cozy under the covers, do I have to get up to get a drink? Grooooan, I don’t want to have to stay up to drink all this water, but hangovers are a drag, wouldn’t it just be easier to do nothing?” “Just let me sleep/scroll a bit longer, maybe I’ll do it tomorrow” nothing wrong with the lazy strategy if it helps). The 12 steps give you different “levels” you are working on, a project you are doing, rather than just not doing something for a while. You can feel accomplished, get a dopamine hit when you win a level (finish a step). Relapse is game over, you lose all your points, start the day counter back up, have to redo the steps. This element sounds unserious but I think is underrated by even AA evangelists for this reason.

SMART recovery does almost the opposite thing to all of the stuff AA does. This includes on sort of irrelevant issues such as the word “alcoholic” itself. AA really like people calling themselves alcoholics, SMART really doesn’t. If you investigate why, there are some practical differences in their programs this can be a vague proxy for (AA starts out with admitting you have no power over alcohol, SMART focuses on personally developing self-discipline and coping tactics. AA wants people to view alcoholism as like a lifelong allergy, SMART defines alcoholism as purely behavioral, and so something you can permanently overcome), but mostly they just use the word in different ways. Both programs want alcoholics (yes, I am going to keep using the word for convenience) to be more humanized, and for them to view themselves as distinct from, and able to rise above the bad actions they have taken in the past. They just view the word as symbolizing basically opposite positions about this.

There are also more functional differences in just how meetings are run, where I typically side with SMART. AA is opposed to “cross-talk”, where people respond to or react to the statements of other people in the group. SMART is for it, and as a result feels a bit less procedural and more conversational (there is still a facilitator to moderate if the cross-talk gets counter-productive). AA is very strict about sobriety, whereas SMART will allow you in meetings even if you are under the influence so long as you don’t talk or cause trouble. SMART also lacks the “religious cult” elements. It is much more humble about its methodology, and less self-serving. It also doesn’t require any version of religion, and that’s one of the most common motives people have for seeking it out as opposed to the much more widespread AA meetings.

It is designed based on CBT, and as opposed to AA which is focused on the 12 steps, has both much more minimal and much more maximal versions. Instead of 12 steps there are “four points”, that represent very broad things that recovering addicts ought to try to pay attention to in sustainable recovery, “Building and Maintaining Motivation”, “Coping with Urges”, “Managing Thoughts, Feelings, and Behaviors”, and “Living a Balanced Life”. In addition to the broad elements, there are tons of more specific exercises. Rather than prose books of the kind AA has, SMART has a workbook you can practice a bunch of different tailored CBT exercises from (and many SMART meetings do a sheet from it during the meeting time).

Because it is less prescriptive about the specific ways to go through each point, people can wind up with a wide range of different strategies that wind up being local favorites at specific locations (whereas with AA, there is a feeling that for every situation there is some sort of obscure lore that the deep AA-heads can quote from like the fifth most famous AA book). I do want to mention one such local favorite that I heard of in a SMART meeting I went to while at rehab, which many people swore by as extremely helpful to them. It’s simple. First, give your addiction a name. Second, when you get urges, scream at it (in your head mostly, but you know, go bananas). Something like “well it wouldn’t be so bad if_” “shut up Frank! Shut up shut up SHUT UP!”

I have tried this a little and it hasn’t felt right to me. I think the most basic reason is that I’m not normally an angry person, and the angriest person I have been was the resentful alcoholic lashing out at my family, so trying to be angry in my recovery feels inherently sort of triggering and identity eroding. More complicatedly, I feel like the intrusive thoughts in my head aren’t some malicious external demon, the most anthropomorphic version of them is like a scared little kid that only knows how to do one thing and needs to be convinced that everything will be alright and is terrified if it isn’t allowed to do the thing. This is sort of connected to the idea that making it long-term is not just about learning not to drink, but learning how to be sober, to prove to this part of yourself that everything will be fine. Of course thinking more bluntly about addiction it’s hard to see as either a demon or scared little kid, it’s a really pervasive cognitive bias, but you can’t yell at that either.

That said, again, a bunch of people swear by this method, and I think it is useful for squaring the circle between two conflicting attitudes: “you are not at fault, you are worth fighting for, this is not you acting” and “you got this, you can make the choice to be sober and make it out”. To make these things compatible, just name the different sides different things. You are the victim, Frank is the abuser, you have power and so does Frank, and recovery is finally being done with the abuse and screaming down Frank’s manipulations.

Finally there’s Dharma. Unfortunately I have very little to say about it because I haven’t been to many meetings. It’s in that unhappy middle where I like it less than SMART meetings, and it’s harder to find than AA. That said, I think it has many similar advantages over AA to SMART. Despite its name it is merely “Buddhist inspired” in the sort of Western, self-help program sense that doesn’t involve very bold metaphysical claims. As far as I can tell, none of its program requires any form of religion to do effectively. It is also not very culty in the ways I described for AA. My big complaint with it is that it basically always involves meditation, which I don’t have any belief which contradicts, but which just never works for me.

That said, it’s a kind of chill environment where you can meditate and share your feelings, and get some decent advice without the AA dogmatism, so if that sounds good to you, try it out. Again, I just haven’t been to enough meetings to give more ringing endorsement or more damning critiques of Dharma recovery. My own recommendation is mostly to try multiple different ones, especially early on.

Appendix C

I hear many people say that “marijuana is not addictive”. This is very silly, I have met numerous marijuana addicts, in fact it is maybe the fourth or fifth most common addiction I see (after alcohol, nicotine, and cocaine, and somewhere close to opiates). Mind you it is also one of the most common substances people casually use, close to alcohol which is a much more common addiction in the (non-random sample of) addicts I meet. I don’t think it is nearly as addictive as some of these other substances, but it is dangerously misleading to tell people it is not addictive. No, it definitely is.

My impression is that people get the idea that “scientifically, weed isn’t addictive” from the fact that you don’t really get physical withdrawal symptoms from it when you stop. This is not what addiction is. If it was just about getting withdrawal when you stop, people would be cured as soon as they went to detoxes, or finished tapering, or white knuckled through withdrawal. Addiction is the thing that drives people to ruin their lives all over again when they try the substance again twenty years later, it is the thing that drives people to relapse on it half an hour after getting out of detox. It is the thing that you feel like you can’t live without, that even when you feel completely confident you will never do it again, you come back the next day. The thing that causes you to keep thinking about using for hours on end on days when you have already decided that you definitely won’t use, and can only silence the obsessive unrelenting thoughts by finally giving in. Marijuana acts ways like these for lots of people. For god’s sake, people get addicted to sex and gambling, where do people get the gall to say that in the case of marijuana, there’s some magic addiction chemical that is absent?

If you took away the withdrawal symptoms from heroin but kept everything else the same, I think it would be incredibly silly to say that you have solved heroin addiction. Silly and dangerous, withdrawal treatment is a very small portion of the addiction related services people use, and indeed it’s my experience that most services require you to have successfully withdrawn before you are access their services. The methadone clinics and heroin detoxes would be pointless, but support groups, rehab, naltrexone, halfway houses, IOPs, will all have basically nothing about their uses affected.

If you want to use it fine, I think it’s ridiculous to outlaw it, especially if you don’t support outlawing alcohol, but you should really treat it like the dangerous and addictive substance it is and avoid certain uses of it. Don’t use it every day. Don’t use it just to get to sleep unless you can figure out a plan for how to stop. Don’t use it to control severe anxiety or depression unless you have a way to stop before too long. Do not attach your identity to being “a stoner”. Don’t use it both to comfort yourself when something bad happens and celebrate when something good happens, and if you do it for these two, for the love of god, don’t use it out of boredom as well. Try not to use alone, but also if you use with others frequently, make sure it is not the only thing you do with your friends (many people have to cut off most of their relationships and face early recovery with little support network because most of their friendships became based on using).

These are all ways that things can go wrong with a substance like marijuana. It won’t always, but you are at more risk if you do these things. If it sounds too hard to avoid them, consider that you may already not be in the most healthy relationship with the substance, and consider quitting while you’re ahead.

Appendix D

This appendix is not going to be some sort of lengthy argument, but basically just a PSA. Like marijuana, I hear some people say that Kratom is not addictive. This is not true. It is not even true in the fairly trivial sense people appeal to for weed where you don’t get withdrawal symptoms. You can get quite nasty withdrawal symptoms from kratom. It is not a common addiction, but as far as I can tell this is mostly because not a ton of people take it yet, and if you get addicted now, the rarity of the addiction just makes things worse for you, because you will have much fewer resources. For what it’s worth, here’s one support group I’m aware of for it.

Just don’t take it as, like, a non-addictive alternative to alcohol or something. It is not as bad as alcohol in various ways, the withdrawal isn’t as dangerous for instance. The same is true of heroin. I hope I’ve already covered in some detail why this is a poor standard on its own for measuring how bad a drug is, and alcohol is just uniquely bad in some ways. Do not take too much comfort in the obvious dimensions kratom is better than alcohol along.