Never Enough: The Neuroscience and Experience of Addiction

Judith Grisel lived a life as a drug addict, before becoming clean and getting a PhD in behavioral neuroscience. Never Enough goes through many different drugs, describing what they do to the body and how they are addictive. She also includes experiences of her own as well as those she knows. Light drugs like caffeine are covered, as are "legal" drugs like alcohol and tobacco. The bulk is spent with discussion on the "street drugs", though the addictive prescription drugs are also given substantial coverage.

The "reversion to the mean" is a part of the issue with drugs. The "highs" are often accompanied by a similar low. Drugs can often simulate natural occurrences. However, the drug can be made very predictable, thus encourage their abuse. Even when there is not a physical addiction, there is often a strong association with the drug and a desire to continue. Often a removal from the environment is needed to break the habit.

After covering the various drugs, the author looks at the general drug epidemic. There is often a social aspect to drug use. However, there is with it a very anti-social flavor, with addicts looking for the high over any other moral beliefs. The author doesn't blame anyone for the drug epidemic, but does believe everyone has some responsibility.

Dopesick

I found myself confused with the messaging in Dopesick. The first part of the book argued that Purdue pharma had forced the opioid epidemic on an unwitting middle-america. It argued that they kept on coming up with "better" opioids that were not as addictive as the previously addictive opioids. Unfortunately, they were over prescribed and ended up being just as addictive. The later part of the book argues that we need better support for treatment options and these treatments should include drugs to help successfully wean people off the drugs. But wait, isn't a "better drug" how we got into this mess in the first place? I do understand that research now shows that the treatment drugs are not addictive. But what if we show later problems?

Aside from this messaging, the book has a scary portrayal of rural America. It gives the impression that these are areas to be avoided. They are just filled with people that are addicted to drugs. They regularly steel and commit other crimes in order to fulfill their drug habit. People from these small towns work their way up from pain relief subscription to drug addict to drug dealer. Once a dealer is knocked out, another one comes into place to fulfill the need. Rural America sounds a crime zone that must be avoided. To add to the misery, there are few job opportunities available and companies are unwilling to move in due to the poor state of the working population. (These regions also often have large number of "non-working" people on disability.)

Big pharma is portrayed as the evil player that thrust this on the people. The drug company reps encouraged doctors to prescribe these medicines to reduce pain. The reps lavished various premiums on the doctors to continue prescribing more. However, the problem is even deeper. "Pain relief" was seen as something similar to a right. The American medical system continues to be based on a system of instantaneous relief without effort. Drugs that can provide this solution are the ideal solution. They are cheaper than therapy or other efforts that require more effort on the part of the patient. The desire for a quick, cheap drug solution helped lead to the big problem. 

Current attempts to address the problem miss the mark. Reducing the drug company monetary  incentives for doctors to prescribe certain drugs is a step in the right direction. However, this is just a small part of the problem. There also needs to be overall reform of the current medical system. There needs to be an incentive for the system to maintain overall health, rather than just look for the quick fix. We also need to make sure people do not slip through the cracks without getting access to treatment they need. The book is a strong advocate for long-term treatment (mentioning the 5 year treatment plans for people such as pilots.) This will be helpful for those already addicted. Though without reforms in the front end, it will be an endless battle with more addictions (and the associated crime, homelessness, despair, and other issues.)

Hooked: Food, Free Will, and How the Food Giants Exploit Our Addictions

Food can be truly addicting. However, the nature of addiction has many different facets. Our food preferences also start when we are young. For many people in the US, the "native food" is the junk fast food that we have grown up with. He have had this food marketed to us from our infancy and continue to prefer it. Some people are much more susceptible to it than others. To some people, a simple ad for McDonalds can trigger the craving. Similar to many other addictions, it is the longing for food that drives it - a longing which can sometimes not be fully satisfied by consuming the food.

The science of how we crave food is interesting. In a study with chocolate lovers, they kept eating the chocolate, even though it stopped bringing pleasure. In other studies with reduced calorie drinks, it was found that a "midpoint" seemed to provide the best experience. Even with things that tasted the same, the body could sense the one that had fewer calories. However, people ended up preferring the one that did not have the most calories. While this could be interesting, there could also be a number of confounding factors. The multiplicity of factors is a regular problem with eating studies. Food is such an integral part of our lives that it is difficult to fully test it out.

This book is well written, but seems to continue on the same themes of the author's previous book (Sugar, Salt, Fat). Food producers love to chase whatever is the "fad" of the day to make what the public "desires". There is a science of producing the ideal taste to maximize revenue. Will junk food end up suffering the same ignominy of big tobacco?