In a hypothetical dream a clam said to a doughnut "mlac mlac", and the doughnut replied in loganberry jamese (which is a difficult language, somewhat akin to Reverse Polish), and I do my best to translate what was said....but caveat lector.....
I read the first post on this thread yesterday, and was initially determined to write a scathing reply ridiculing the stupidity of researchers in the medical field, but this morning I read the article and I realized that there was a grain of truth in what was said.
However, let's look at the numbers, but before we do so I'm going to add explicitly the definitions given in the first link of the original post.
I shall mention in passing the inadequacy of these definitions but leave it at that. Let's look at Withdrawals to begin with. Is it just me or is it overly convenient, or falsely elegant that we have a list of substances with the "scores on the doors" (don't worry, it's a quiz show) 6,5,4,3,2,1
respectively? Yep, in my guise as master scather, disparager, castigator and general pooh-pooher of the idiotic and fatuous I shall begin here. Let us reason from within, and begin with Alcohol
getting a score of 3. I have used all of these substances on a daily basis for reasonable (or should I say unreasonable lengths of time) and the two I'd say I got the least withdrawals from were alcohol and marijuana
. Now I've used alcohol to semi-serious excess, and I've definitely had a desire to use it, and I've clock watched for 12 noon, which was nearly always the earliest I allowed myself a drink. I've got itchy, but I'd have to say, for me, no withdrawal. The point of this is to say that a score of 3 must imply we are talking about long-term alcohol use. Alcohol, like benzodiazepines is lenient in that a few months daily use is unlikely to establish bad physical addiction. [Do not try this experimentally. I'm speaking from personal experience of being able to stop benzos cold turkey with little or no withdrawal after 2-3 months of use. I stopped fairly painlessly after 6 months use too, but I have fitted out when stopping cold turkey after longer use. Looking back what I did was dangerous and stupid. But I was young and stupid then, not old and stupid like now. I've found the longer-acting benzos that I used (temazepam, diazepam, chlordiazepoxide) more "forgiving" than the likes of midazolam and especially alprazolam, that to my mind (I initially wrote wind, a good typo!) seem very addictive]. If alcohol is to have a withdrawal, then because it's the only drug
on the list that has a potentially fatal withdrawal, surely it should, on one rating be top of the heap? Alcohol withdrawal may be the most dangerous, but is it the most unpleasant if properly managed? I'd guess not, basing my experience on one case of serious alcohol withdrawal I partially witnessed in rehab. There was some kind of crisis (the guy in question had been drinking of the order of 2 bottles of vodka a day for 20-30 years, so we are talking serious alcoholism), and he had to go to hospital, but he came back, and after a short time seemed not too bad. By way of comparison most of the alcoholics seemed to experience no externally noticeable withdrawals, and if medicated at all were given a few days of benzos
. Alcoholism to the point of withdrawal (and I don't mean shakes the next day), requires dedication to the cause.
It's a shame benzos and barbiturates aren't covered here. It would give us a clue as to the mindset of the author. OK so let's look at the 5,4,3 part of the ordering "heroin
, alcohol", and mutter and splutter about comparing apples and oranges. A crack
comedown is not comparable with heroin withdrawal. A bad crack comedown is in terms of its immediate intensity (tautologically speaking!) bad. I'd all but cry even if I had heroin and curse that I'd bought "brown" instead of (as well as) "white"! Heroin barely touched a crack comedown for me. But a few hours later that insanity was gone; but do we factor that low grade next day "I want a pipe of crack, I'm listless" into the withdrawals? Probably not, that will be part of habituation more. However we score this how does it compare to 7-10 nights or more with little or no sleep and every second of the clock seeing like an eternity. I think in some sense the "heroin, cocaine, alcohol, caffeine
, marijuana" scoring 5,4,3,2,1 is fine.
Now, then here we come to the bone of contention. Above heroin withdrawal we have nicotine
withdrawal with a score of 6. I have just emerged from a methadone
withdrawal, which some readers will probably know is documented in more than a little detail in the "Screaming in the night air" thread (in recovery and addiction
addiction). I think there is a general consensus that a methadone withdrawal is about a 5-6 to heroin's 5, but I would defy anyone in good conscience to read that thread, look me in the eye and say "Dickon, that was maybe a less than pleasant experience. However I quit smoking the other month, and trust me my withdrawal symptoms were far worse than yours".
I was a 40 a day smoker, and when I quit finally I was smoking 60-80 a day. Comparable to or worse than caffeine and marijuana: yes definitely. Comparable to or worse than alcohol or cocaine: there is a point to be made, if you're going to claim nicotine has withdrawal symptoms at all. It IS hard to quit, don't get me wrong, but to claim it is in re withdrawal symptoms comparable to opiates
is fatuous in the extreme. It's wrong
. If I were MrG, I'd do a long line of "Ha ha"s in ever increasing size. It's not just wrong, it's really wrong. It's so wrong as to derail the credibility of the author, in my opinion at least.
Please note that what I've said so far does not refute the claim that nicotine is more addictive than heroin. The strength of this claim I now see rests on the "fact" (if we believe the research) that of people who try heroin only x % become addicted, but of those who try nicotine y% become addicted, where y>x. In this sense the claim is plausible, and puts no constraints on the severity of withdrawal symptoms.
Right let's skip through the other categories, as this post is already turning into one of my longer numbers. Reinforcement next. Cocaine. Let me quote a less than perfect section of wiki under "cocaine dependence". Sources are not given, and the grammar leaves a little to be desired but I've seen this information before, so I'm inclined to believe it: -
One study showed that a rhesus monkey named Brekke, provided with a mechanism of cocaine self-administration, preferred the drug over food that was in the cage. This happens even when the monkeys are starving. Female monkeys with offspring will abandon their young upon being introduced to cocaine, and in a few cases, mothers killed their offspring. In all cases, a monkey aggressively protected the apparatus which delivered the cocaine, and in most cases, fights to the death between monkeys occurred to secure access to cocaine. The monkeys who self-administered cocaine, did virtually nothing else. Complete disregard for food, sex, sleep, water, hygiene, offspring, and life in general was always the case for those monkeys addicted to cocaine [this was then contrasted with the more normal behaviour if the cocaine was replaced with heroin].
This behaviour (remember the definition of reinforcement is for animals too) get's a 3. Alcohol get's a 6, heroin a 5 and nicotine a 4. Go figure [If this is true, I'm never standing in the way of a man returning for a second pint at the pub. Not only will I be killed, but most likely my child and wife will be too]. If we're going to unpick this rainbow, cocaine is a 6 on reinforcement. Everything else pales into insignificance. Of the top of my head I'd place nicotine second, heroin third, then caffeine or alcohol, and finally Mary Jane. Again, giving cocaine a 3 here shows either a set of criteria to define reinforcement that fly in the face of normal usage and common sense, or results that for whatever reason are simply wrong.
The rest of the numbers do not, by my reckoning, fly in the face of common sense. Heroin is the most prone to tolerance. It's not unreasonable to put nicotine next (compare the little effect smoking 80 a day has for a smoker compared to one puff for a non-smoker).
It's a thought provoking idea, but I am not yet convinced we've got very good axes for comparison. I'd love to know how other people with experience of daily use of all or some of the above substances rate them subjectively by the above criteria, or sub-divide them/clarify them/explain them better. Without some-such even subjective scorings would be rather arbitrary.
Excuse the rambling, but hope it was interesting or intelligible at least.