Another explanation is that getting illegal drugs is hard and dangerous. As you age, you become less aggressive and willing to hang out with violent drug dealers since they might hurt you. That’s compatible with the family roles explanation but is less face saving since nobody wants to admit they are too scared to do drugs
In most places I have lived (many different urban areas in the US) getting small quantities of many illegal drugs is neither hard nor particularly dangerous. Using them can be dangerous, of course, but it's trivial to buy fentanyl, crack, or methamphetamine where I live.
I also think it’s just too much effort in general for the payoff. It’s not like a bottle of wine (or whatever) that you can pick up any time in any store.
You need to have a contact/place and coordinate (smartphone has made that easier though) and it becomes more effort than it’s worth to you, especially since there is always the risk that you get caught or into trouble.
It’s not just fear, there is a real costs/benefits analysis that people do subconsciously and once you have an established life there is a lot to lose but drugs are fun for a short period of time…
Moral of the story is: if you find out your kid is addicted to heroin, don't worry about it! According to Dr Caplan, it's just a phase. They'll grow out of it!
but one of the biggest problems of having an addicted child is that is sometimes being required to "abandon" them, because they've accepted the implications of their criminal status. Since there's so much Taboo phoniness and hypocrisy and concealment, under the current regime of criminalization.
And there are more kinds of libertarian tendency than the extreme that emphasizes isolated egoistic individualism to the exclusion of all other concerns.
There are entirely too many people dealing in rigid categorical ideological judgements on Substack. I don't judge people as midwits--I've known too many humans who have hidden depths. But Ideological fealty and unquestioning dogmatism leave everyone less intelligent than they otherwise would be.
Why should everyone be deprived of their freedom to marginally help a tiny, self-destructive minority? Let's say there are two groups of people: Group A and Group B. For Group A, easy access to drugs and alcohol adds pleasure to their lives with very little pain. For Group B, that same easy access leads them down a path of self-destruction. What's more important: Group A's pleasure or Group B's pain? I see Bryan's answer and the typical libertarian response favoring Group A, while paternalists favor Group B. (I am patiently waiting for Bryan's next book where he argues against paternalism.) I am more paternalistic than the typical libertarian but reject most arguments for paternalism (“medicalization”). Yes, many people are impulsive and weak-willed, but I believe the state can help protect them from their own vices. My solution is the meritocracy of vice: legalize alcohol and drugs but make them very expensive, and impose harsh punishments on anyone who sells them illegally.
I think about it the same way. The big problem I have with prohibition and the tax-regimes is that they don't work. After decades and billions of dollars of warring on drugs, all they've managed to do is eroding our civil liberties. They can't show any significant and lasting reduction in drug use.
And de criminalization hasn’t worked. All the blue cities/states made a big deal of decriminalizing hard drugs a few years back and now they all consider it a disaster and they are rolling it back.
The method of making alcohol legal, hard drugs illegal, And pot somewhere in the middle is just a winning formula.
The Hardline approach to suppressing drug use by the common people sometimes works- for a while. Only for a while. It's also Totalitarian.
There's so much confusion about this issue that not many people have worked it out. A couple of the "blue" jurisdictions passed decriminalization of all drugs--but they fell down drastically on enforcing the responsibilities that are required to balance that freedom. Public drugs use was permitted--notably by the most visible and dysfunctional population on the streets. A population that had gotten accustomed to impunity for living on city streets as petty criminals and vagrants. The "decriminalized" users were allowed to grab turf in public parks and on sidewalks, to use in groups. Groups organized around what? Scoring from the retail dealers in their midst.
You'd have to be a Bliss Ninny Liberalcrat to not have foreseen that outcome. (Yes. I'm homeless myself. Politically.)
User decriminalization can work. (And it's a damn good thing that alcohol users weren't criminalized during Prohibition, the way that illicit drug users have been for my lifetime.) But it has to be done along with a priority of saying No to a whole lot of antisocial behaviors that have been increasingly ignored as the problem of Mass Criminalization has snowballed over the decades.
The blue states dont follow bryan’s perferred policy of decriminalizing while at the same time stigmatizing abuse and cracking down on vagrancy, use on the streets, violent crime etc
Yeah, people who are ok with individuals blowing up their lives in the pursuit of dangerous drugs also tend not to police disorder of all kinds.
Let’s consider what this looks like in practice. In 2020 George Floyd got high on what may have been a lethal dose of fentanyl. He then proceeded to commit a crime and resist arrest. The process of trying to arrest him led to his death, and the great national freak out that followed.
That’s what “policing people that are high” looks like in real life. It’s messy and creates incidents. It’s way easier for them to just not get high in the first place.
it's amazing to me when hardline prohibitionists use examples that have occurred under conditions of criminalization. especially when they deplore the amount of use of forbidden drugs "by the children." In an illicit market the kids aren't just taking drugs, they're the people running the retail market. Oh, and illicit business is a Glamour Profession.
Ironically, commercial legalization of a given substance also allows for regulation--including a standard of age restrictions that's potentially strictly enforceable. That isn't the only consideration, of course.
1) The physical impact that the drug has (does it make people violent inherently, etc)
2) The level of addictiveness
3) Its current state in society (its easier to not let a drug get a foothold then it is to try to ban something widely used).
This can lead to all sorts of answer ranging from total probation (which probably makes sense with hard drugs) to a variety of regulator regimes.
It's also worth noting that "commercial legalization" tends to lead to spreadsheet jockeys and chemists min/maxing until they achieve maximum exploitation of human weakness in order to maximize profit. This applies to more then drugs (just look at how online sports betting has exploded and had many negative effects).
I did not mention prohibition, i do not think we should ban drugs or alcohol. Just make them expensive and punish severely anyone who sells them illegally. That may not work.
On prohibition the literature is all over the place some say it did more good than harm.
Canada tried sky high taxes on cigarettes a while back. The taxes were so high that organized crime became involved in smuggling untaxed cigarettes. There was turf wars.
Canada had actual gang turf wars over cigarette smuggling in the ‘80s. I didn’t follow it closely. I don’t know if they cracked down, or lowered the taxes, or ignored the smuggling and everything that entails.
I sincerely doubt that and in any case it is largely dependent on strong borders or unified pricing.
Last I looked in France sales volume supposedly lowered (because there have been a lot of increases) but production volumes stayed constant in EU with sales increasing in bordering countries of France.
On top of that there has been a lot of grey market sales (“counterfeit” smuggling from foreign countries) and my neighbor tobacconist told be the story of a giant “counterfeit” manufacturing operation 50km from where I live that produced over one ton per month (has been dismantled).
All the stats on smoking prevalence I could find showed a steady rate (younger people don’t necessarily smoke cigarettes but instead vapes).
On top of all that I know for a fact that some people started cultivating tobacco (even though it is highly illegal of course), because the economics makes it so that when the price get very high you don’t need a very large scale to be competitive even if it’s just for your own consumption (and friends).
So I would say if you are Australia you might be able to get away with it. For most countries in the world it is not a realistic policy.
What is actually “killing” smoking is the cultural acceptance of it, or in that case lack thereof.
It has been forbidden in many places (almost everywhere nowadays) and properly diabolized.
It is now generally seen as bad taste to be smoking and that’s really the big difference maker because it avoid all those who would smoke just to fit in or look cool of doing so.
Those who really like it and have an addiction to nicotine won’t really stop that easily.
It’s almost impossible for the government to control black/grey market supply (since they can’t do that with the “hard” drugs anyway) and if they raise the price enough that it’s comparable to something like cannabis (per gram for logistics reasons) it’s going to get picked up by the same type of people who already sell the other stuff.
There is an undeniable correlation between higher state excise tax rates and reduction in smoking rates in those states. You're right that causation is not provable and that other factors definitely contribute, with reductions in smoking rates occurring in both high and low tax states. I overstated causation, sorry.
I even think you're right that social norms and medical information have had a bigger impact.
Dismissing the potential impact of taxes out of hand is definitely unfair though. Smuggling/black market trade does not by definition replace reduced sales in legal markets due to taxation
I definitely think high taxes have an impact because it "convinces" the people who just do it out of habit and won't put the effort to find an alternative, to quit.
But what I mean is that at some point it can have the reverse effect because there will be consumers regardless of prices (just like the illegal drugs).
If policy goes too far and unintentionally "creates" a too good grey/black market, people will pick it up again. I know someone who works on a boat and always comes back with duty-free cigarettes because there is always someone to buy below the government fixed price.
When the potential profit gets too good, you get many people doing the same (even if they don't smoke themselves) and then it's just blurring the real statistics while costing government tax revenue.
In other words, I think there is an effect similar to the Laffer curve going on and in an open border country they need to not overdo the taxation.
I work in addiction medicine, so I am more disposed to view addiction as a disease. I'm willing to challenge my priors (and curious about your priors), but your analysis is incomplete.
I agree that many people age out of addiction. I agree that this understanding is not widespread, and the worst consequences of that have been overly punitive drug laws and excess social stigma long past the point of any utility.
I also agree that personal agency is an important part of recovery and that more engagement with adult life and responsibilites help people recover. Also that mental health comorbidities make it harder to recover (this is very well understood by addiction treatment providers)
A couple issues with the analysis:
1) Old data vs. new realities: the treatment approach to the most common substance use disorders (alcohol and opioids) has changed quite a lot even since 2005.
Namely, the last two decades have seen widespread use of buprenorphine and naltrexone for opioid and alcohol use disorder (naltrexone only for AUD of course)
These medications have changed things a lot and are genuinely different than any treatment being used in the 1980s or in wide use in 2005.
2) Overly broad definitions
The details of this research matter, especially in the definition of treatment.
If treatment is 30 day detox and quickie rehab, then yes I think there is a reasonable case that it's ineffective.
If it's a 1 year residential program designed to train people in job skills and interpersonal skills, then I'd need a lot more evidence to convince me.
If it's methadone, then I would argue that the problems with methadone treatment are real (mostly because of the stupid way it is regulated, though the drug itself is also less than ideal) but it does meaningfully reduce the risk of deadly overdose and relapse.
3) Self selection bias. It may be that people who seek treatment have more severe issues.
You're missing a column for people who sought or wanted treatment but didn't get it.
Even if your analysis were solid, I find your conclusion somewhat cruel. Some might look at the same set of facts and think, "we need to figure out how better to help the people who have comorbid mental health and addiction disorders."
It's good to have someone with professional expertise commenting on this. Hopefully that expertise includes ground-level experience.
One important "confounding factor" that needs to be considered is that a hefty fraction of people addicted to hard drugs die young. Often very young. Lethal overdose is the problem that's most discussed, and the death toll from fentanyl has been particularly dramatic, but it isn't the only hazard of hard drug addiction. A sizeable fraction of people on dialysis are drug addicts, or former drug addicts. Dialysis is, tragically, an end-of-life support that often does not extend beyond 5 years. There are disabling impacts from nonlethal overdoses. Addiction plays havoc with nutrition, with desire to engage in physical activity, the immune system and neurochemical system. Needle use on the street or in the criminal subculture is fraught with health perils.
I don't know how much of the problem might be related to the iatrogenic effects of the Drug War, but while most alcoholics seem to make it to their 60s, a large number of opioid addicts don't make it out of their 20s, and many more don't make it as far as age 50.
It's frustrating to outsiders, because "confirmed addiction" is so resistant to intervention. But I think maybe the most important component is simply being out of the life and completely away from drugs for at least one year. Not that it's a guarantee, but many addicts haven't even had the opportunity. (Doing 30 day stretches in jails with a thriving drug trade is not the same thing.) Fentanyl is a particularly bad scene, because addicts live on a foreshortened horizon of their next fix to avoid coming down and getting sick, and with fentanyl that's only 4-6 hours.
I would say I'm pretty ground level - my work involves a lot of buprenorphine prescribing and conversations with people addicted to drugs or in recovery.
You're right that the morbidity of drug addiction matters as much as the mortality. Some drugs are particularly hard on the body, alcohol being the worst, but even relatively benign drugs can have devastating psychological consequences. Self-neglect is common.
This is another reason that I think approaching addiction as merely a question of preference fundamentally misunderstands the issue.
Also, yes. The best predictor of long term sobriety is (circularly) shorter term sobriety. This is where medical intervention can play a really important role. For example, my fentanyl addicted patient might eventually stop using on their own (if they don't die first), but treatment with opioid replacement can get them there much sooner.
My usual advice is to stick with buprenorphine for at least a year, and meanwhile people build relationships and obligations removed from the world of hard drug use.
Separating briefly the idea of being a raw utilitarian +/- from whether we should bite the bullet on allowing people freedom to do self destructive stuff…
It does seem like a negative EV decision to use drugs with modestly positive modal effects on wellbeing, such that even though most people are very modestly worse off by banning drugs, we’re in expectation better off as an average member of society.
There are probably some sub populations for which that’s not true. Like if we could restrict drug use to only high income households with stable family environments, we probably cut off much of the long tail of bad outcomes, but that doesn’t seem super politically feasible
The fact that drug use is concentrated among the young feels like not a favorable tilt as it relates to externalities. It would be far preferable that drug use were concentrated among elderly populations with fewer young children and spouses who suffered the collateral damage.
I broadly agree that people shouldn't use random abbreviations, but in the comments section of an economics blog it's not crazy to think people will recognize Expected Value (EV).
Astounding to hear that MBAs and CPAs aren't thinking about Expected Value often enough to have "negative EV decision" auto-update to "negative expected value decision" as soon as they see or hear it.
But yeah, broadly I'm totally in agreement that you shouldn't use acronyms unless they're first defined - it doesn't take many cases like this of failed communication to make the use of EV negative EV with respect to meaning communicated per word typed :p
I was actually bottom of my class at Wharton in '68, and just squeaked by with my CPA 5 years later with a 78 (75 to pass), so ...
I'm substandard - bottom of the barrel. I really shouldn't be trying to read difficult material like this. Back to network television for me. Give my feeble, old brain a much-needed rest.
The concept that most age out of addiction also supports the benefits of treating it as a “disease” and using medication assisted therapy such as suboxone or methadone, no? Or harm reduction approaches in general. You can remove the impulsive drive for the substance for several years until they age out and are no longer at risk of an overdose that
If you regard it as a self-limited disease, then you don’t necessarily have to offer treatment of any sort. Medical science is replete with “remedies” for things that get better without treatment.
Buprenorphine is very effective for reducing overdose death and relapse from opioids. It is a partial agonist opioid with minimal euphoric or psychiatric side effects that is very hard to overdose on (maybe impossible)
Naltrexone and acamprosate are effective for reducing relapse on alcohol and heavy alcohol use. Other meds also have good evidence.
GLP-1 agonists (your ozempics, etc) are very promising for addiction disorders and trials are in progress.
Longitudinal or retrospective research from the 1980s and mid 2000s would not reflect how much the reality has changed over 20 years.
From a personal perspective, I have patients who would NOT have "aged out" who are functioning and working because of these therapies. I also have some that probably would have aged out.
I think the author was advocating more for an end to strict drug prohibition, which I heartily agree with. But the idea that treatment is useless is just untrue in 2025
Whose goal? I work on the theory that the person choosing to use drugs, however sourced, accepts the risk of doing so, and lives or dies with the consequences. I’m not convinced that “society” can make drug use safe, especially the illegal drugs. They are illegal because they are unsafe.
When made in a state of the art way they are not unsafe by themselves. They are juste easy to abuse. I mean the US had an opioid epidemic with very safe very legal drugs…
It’s the potential for abuse that is the danger and since it is wildly different for everyone but definitely much worse for weak people we prefer to ban them.
And being illegal it precisely when it becomes more unsafe. Because they’ll be sold by shady individuals that might have botched the work, cut it with dangerous stuff and just plain lie about what they are selling. There’s no quality control and no hygiene, it’s basically a gamble, even though in most case it’s not too bad (you have more chance to be scammed than anything else really).
But people still consume plenty of drugs, they just go see a doctor to get a prescription and voila, it’s legal.
The whole discourse around drugs is hilarious hypocrisy. It is first and foremost governments enforcing their monopolies on taxation (and violence).
If you get drugs in a sanctioned system where they can tax every single transaction they don’t care.
There's a major problem with the study: it's lumping all the drugs together. I suppose I'll have to read the primary source to find the exact details.
Since the DSM considers "Cannabis Use Disorder" to be "drug dependency disorder" basedon fairly nebulous criteria, that potentially throws the study off the most. But even if cannabis were to be excluded, each substance deserves its own profile. The trajectory of dependency and duration of ongoing use are different for each substance.
No, the moral of the story is: don't categorize people as criminals from the moment of their first willing experimentation with restricted or prohibited mind-altering substances. Parental communication is not enabled by an official policy that officially ordains a child with Criminal status for ingesting a mind altering substance. Drug use is not inherently malum in se criminal behavior. Use of addictive drugs does not result in 100% of the user cohort being addicted to them, either. Not even a majority being addicted to them.
The supply should certainly be controlled by regulation and restriction--including prohibition, in some cases. But the bottom line is that mass criminalization has had a more profound impact on our society than mass incarceration, which has been only one of its consequences. For a population by definition involved in criminal activity, the question of whether or not someone has been arrested is less important than the question of whether they could be arrested for it. That's arguably the original Cancel Culture: America's mass cancellation of Dopers. And also introducing matters of Social Status Privilege into the mix. Including the subversion and inversion of that hierarchy. Infuriating, isn't it?
Do you realize that simple possession of alcohol was not a criminal offense in the 1920-1933 Alcohol Prohibition era? There were a few localities that had a possession offense on the books, but it was rarely enforced, and not with jail sentences.
This is a separate issue from the dysfunctional addict population on the streets, who commit actual malum in se* criminal offenses on the regular and who would benefit from a good solid year in a locked rehab facility like a tent camp in a jail that is competent enough to ENSURE that there is no drug use or drugs trade within the walls. An addicts only jail, for nonviolent offenders. And if they relapse into dysfunction and end up on the street again, they go in for another year of dryout time. (Choice posed to someone determined to go back to their habit again: either stay clean long enough to maintain a functional legal hustle, or go back to it immediately, get rousted, go into forced rehab again. Get a functional hustle, you might decide to hell with going back to drugs.)
[*Most of them admittedly petty, but still. And in this case, they have a way of adding up.]
Your Bet On It piece on aging out of drug addiction is a sharp take on how time and maturity can shift the tides of dependency, offering a hopeful lens on a tough journey. I leaned on marijuana for over a decade to manage chronic pain and break free from VA-prescribed opioids, but quit when it became too potent and riddled with untrustworthy pesticides and herbicides. The withdrawal unleashed a torrent of vivid dreams as my brain rebooted REM sleep, a raw shift I detailed in an article to guide others through recovery’s unexpected turns. Your point about aging bringing perspective resonates—sometimes it’s the years that teach us to choose ourselves over the haze. If my article strikes a chord, I’d be thrilled if you subscribed to my Substack for more recovery insights! Full article: https://sleuthfox.substack.com/p/want-your-dreams-back #AgingOut #SoberPerspective #RecoveryRoad #MarijuanaRecovery
Is it a felony for MIT duke UNC Chapel Hill et al to lie about the DOB and date of PhD 1988 like me to hide fact that pastrami face Ariely got burned in Beirutarch 8 1985 mossad attack?
Typical outdoor sport rock climbing is 3 micromorts, 1 death per 320,000 climbs (UK HSE). Mountaineering is much more dangerous at 2800 micromorts per climb ( Matterhorn), and Everest is 38000. I'm guessing he's thinking of the latter.
Another explanation is that getting illegal drugs is hard and dangerous. As you age, you become less aggressive and willing to hang out with violent drug dealers since they might hurt you. That’s compatible with the family roles explanation but is less face saving since nobody wants to admit they are too scared to do drugs
In most places I have lived (many different urban areas in the US) getting small quantities of many illegal drugs is neither hard nor particularly dangerous. Using them can be dangerous, of course, but it's trivial to buy fentanyl, crack, or methamphetamine where I live.
That relies on people being able to quit their addiction, contrary to all the prohibitionists' claims.
I also think it’s just too much effort in general for the payoff. It’s not like a bottle of wine (or whatever) that you can pick up any time in any store.
You need to have a contact/place and coordinate (smartphone has made that easier though) and it becomes more effort than it’s worth to you, especially since there is always the risk that you get caught or into trouble.
It’s not just fear, there is a real costs/benefits analysis that people do subconsciously and once you have an established life there is a lot to lose but drugs are fun for a short period of time…
Moral of the story is: if you find out your kid is addicted to heroin, don't worry about it! According to Dr Caplan, it's just a phase. They'll grow out of it!
Or most users are not addicts?
And if you actually disliked this behaviour so much, you could just abandon your child ;) Libertarianism is a wonderful philosophy.
but one of the biggest problems of having an addicted child is that is sometimes being required to "abandon" them, because they've accepted the implications of their criminal status. Since there's so much Taboo phoniness and hypocrisy and concealment, under the current regime of criminalization.
And there are more kinds of libertarian tendency than the extreme that emphasizes isolated egoistic individualism to the exclusion of all other concerns.
There are entirely too many people dealing in rigid categorical ideological judgements on Substack. I don't judge people as midwits--I've known too many humans who have hidden depths. But Ideological fealty and unquestioning dogmatism leave everyone less intelligent than they otherwise would be.
And I am reminded of something I learned in Arkansas. The only people in favor of prohibition are the moonshiners and the ministers.
Why should everyone be deprived of their freedom to marginally help a tiny, self-destructive minority? Let's say there are two groups of people: Group A and Group B. For Group A, easy access to drugs and alcohol adds pleasure to their lives with very little pain. For Group B, that same easy access leads them down a path of self-destruction. What's more important: Group A's pleasure or Group B's pain? I see Bryan's answer and the typical libertarian response favoring Group A, while paternalists favor Group B. (I am patiently waiting for Bryan's next book where he argues against paternalism.) I am more paternalistic than the typical libertarian but reject most arguments for paternalism (“medicalization”). Yes, many people are impulsive and weak-willed, but I believe the state can help protect them from their own vices. My solution is the meritocracy of vice: legalize alcohol and drugs but make them very expensive, and impose harsh punishments on anyone who sells them illegally.
I think that's better than letting them age out.
I think about it the same way. The big problem I have with prohibition and the tax-regimes is that they don't work. After decades and billions of dollars of warring on drugs, all they've managed to do is eroding our civil liberties. They can't show any significant and lasting reduction in drug use.
I would (do) oppose the present war on drugs EVEN IF it worked, if only for the billions of dollars and (especially) erosion of individual rights.
The war on drugs worked in east Asia.
And de criminalization hasn’t worked. All the blue cities/states made a big deal of decriminalizing hard drugs a few years back and now they all consider it a disaster and they are rolling it back.
The method of making alcohol legal, hard drugs illegal, And pot somewhere in the middle is just a winning formula.
The Hardline approach to suppressing drug use by the common people sometimes works- for a while. Only for a while. It's also Totalitarian.
There's so much confusion about this issue that not many people have worked it out. A couple of the "blue" jurisdictions passed decriminalization of all drugs--but they fell down drastically on enforcing the responsibilities that are required to balance that freedom. Public drugs use was permitted--notably by the most visible and dysfunctional population on the streets. A population that had gotten accustomed to impunity for living on city streets as petty criminals and vagrants. The "decriminalized" users were allowed to grab turf in public parks and on sidewalks, to use in groups. Groups organized around what? Scoring from the retail dealers in their midst.
You'd have to be a Bliss Ninny Liberalcrat to not have foreseen that outcome. (Yes. I'm homeless myself. Politically.)
User decriminalization can work. (And it's a damn good thing that alcohol users weren't criminalized during Prohibition, the way that illicit drug users have been for my lifetime.) But it has to be done along with a priority of saying No to a whole lot of antisocial behaviors that have been increasingly ignored as the problem of Mass Criminalization has snowballed over the decades.
The blue states dont follow bryan’s perferred policy of decriminalizing while at the same time stigmatizing abuse and cracking down on vagrancy, use on the streets, violent crime etc
Yeah, people who are ok with individuals blowing up their lives in the pursuit of dangerous drugs also tend not to police disorder of all kinds.
Let’s consider what this looks like in practice. In 2020 George Floyd got high on what may have been a lethal dose of fentanyl. He then proceeded to commit a crime and resist arrest. The process of trying to arrest him led to his death, and the great national freak out that followed.
That’s what “policing people that are high” looks like in real life. It’s messy and creates incidents. It’s way easier for them to just not get high in the first place.
what djerzinski said.
it's amazing to me when hardline prohibitionists use examples that have occurred under conditions of criminalization. especially when they deplore the amount of use of forbidden drugs "by the children." In an illicit market the kids aren't just taking drugs, they're the people running the retail market. Oh, and illicit business is a Glamour Profession.
Ironically, commercial legalization of a given substance also allows for regulation--including a standard of age restrictions that's potentially strictly enforceable. That isn't the only consideration, of course.
Drug restriction has to account for:
1) The physical impact that the drug has (does it make people violent inherently, etc)
2) The level of addictiveness
3) Its current state in society (its easier to not let a drug get a foothold then it is to try to ban something widely used).
This can lead to all sorts of answer ranging from total probation (which probably makes sense with hard drugs) to a variety of regulator regimes.
It's also worth noting that "commercial legalization" tends to lead to spreadsheet jockeys and chemists min/maxing until they achieve maximum exploitation of human weakness in order to maximize profit. This applies to more then drugs (just look at how online sports betting has exploded and had many negative effects).
In this case the drug floyd was consuming is already criminalized
The penalties for drug use in East Asia were draconian.
it didn't work, Bob. You're living in a low-information factoid fantasyland.
Yeah, you can win wars you actually fight.
as if it were that simple, lol. the entire "war on drugs" paradigm is a vast, ccorrupt joke, and it needs to be retired.
I did not mention prohibition, i do not think we should ban drugs or alcohol. Just make them expensive and punish severely anyone who sells them illegally. That may not work.
On prohibition the literature is all over the place some say it did more good than harm.
How do you make them expensive? By punitive taxation as done with cigarettes?
Won't it just encourage smuggling and black-marketing?
And we are back to to the square one.
Despite high cig and alcohol taxes the vast majority of people acquire them in the legal markets.
Canada tried sky high taxes on cigarettes a while back. The taxes were so high that organized crime became involved in smuggling untaxed cigarettes. There was turf wars.
Canada had actual gang turf wars over cigarette smuggling in the ‘80s. I didn’t follow it closely. I don’t know if they cracked down, or lowered the taxes, or ignored the smuggling and everything that entails.
High cigarette taxes are among the most effective anti smoking policies https://pmc.ncbi.nlm.nih.gov/articles/PMC3228562/
I sincerely doubt that and in any case it is largely dependent on strong borders or unified pricing.
Last I looked in France sales volume supposedly lowered (because there have been a lot of increases) but production volumes stayed constant in EU with sales increasing in bordering countries of France.
On top of that there has been a lot of grey market sales (“counterfeit” smuggling from foreign countries) and my neighbor tobacconist told be the story of a giant “counterfeit” manufacturing operation 50km from where I live that produced over one ton per month (has been dismantled).
All the stats on smoking prevalence I could find showed a steady rate (younger people don’t necessarily smoke cigarettes but instead vapes).
On top of all that I know for a fact that some people started cultivating tobacco (even though it is highly illegal of course), because the economics makes it so that when the price get very high you don’t need a very large scale to be competitive even if it’s just for your own consumption (and friends).
So I would say if you are Australia you might be able to get away with it. For most countries in the world it is not a realistic policy.
What is actually “killing” smoking is the cultural acceptance of it, or in that case lack thereof.
It has been forbidden in many places (almost everywhere nowadays) and properly diabolized.
It is now generally seen as bad taste to be smoking and that’s really the big difference maker because it avoid all those who would smoke just to fit in or look cool of doing so.
Those who really like it and have an addiction to nicotine won’t really stop that easily.
It’s almost impossible for the government to control black/grey market supply (since they can’t do that with the “hard” drugs anyway) and if they raise the price enough that it’s comparable to something like cannabis (per gram for logistics reasons) it’s going to get picked up by the same type of people who already sell the other stuff.
There is an undeniable correlation between higher state excise tax rates and reduction in smoking rates in those states. You're right that causation is not provable and that other factors definitely contribute, with reductions in smoking rates occurring in both high and low tax states. I overstated causation, sorry.
I even think you're right that social norms and medical information have had a bigger impact.
Dismissing the potential impact of taxes out of hand is definitely unfair though. Smuggling/black market trade does not by definition replace reduced sales in legal markets due to taxation
Yes I worded my post too strongly.
I definitely think high taxes have an impact because it "convinces" the people who just do it out of habit and won't put the effort to find an alternative, to quit.
But what I mean is that at some point it can have the reverse effect because there will be consumers regardless of prices (just like the illegal drugs).
If policy goes too far and unintentionally "creates" a too good grey/black market, people will pick it up again. I know someone who works on a boat and always comes back with duty-free cigarettes because there is always someone to buy below the government fixed price.
When the potential profit gets too good, you get many people doing the same (even if they don't smoke themselves) and then it's just blurring the real statistics while costing government tax revenue.
In other words, I think there is an effect similar to the Laffer curve going on and in an open border country they need to not overdo the taxation.
I work in addiction medicine, so I am more disposed to view addiction as a disease. I'm willing to challenge my priors (and curious about your priors), but your analysis is incomplete.
I agree that many people age out of addiction. I agree that this understanding is not widespread, and the worst consequences of that have been overly punitive drug laws and excess social stigma long past the point of any utility.
I also agree that personal agency is an important part of recovery and that more engagement with adult life and responsibilites help people recover. Also that mental health comorbidities make it harder to recover (this is very well understood by addiction treatment providers)
A couple issues with the analysis:
1) Old data vs. new realities: the treatment approach to the most common substance use disorders (alcohol and opioids) has changed quite a lot even since 2005.
Namely, the last two decades have seen widespread use of buprenorphine and naltrexone for opioid and alcohol use disorder (naltrexone only for AUD of course)
These medications have changed things a lot and are genuinely different than any treatment being used in the 1980s or in wide use in 2005.
2) Overly broad definitions
The details of this research matter, especially in the definition of treatment.
If treatment is 30 day detox and quickie rehab, then yes I think there is a reasonable case that it's ineffective.
If it's a 1 year residential program designed to train people in job skills and interpersonal skills, then I'd need a lot more evidence to convince me.
If it's methadone, then I would argue that the problems with methadone treatment are real (mostly because of the stupid way it is regulated, though the drug itself is also less than ideal) but it does meaningfully reduce the risk of deadly overdose and relapse.
3) Self selection bias. It may be that people who seek treatment have more severe issues.
You're missing a column for people who sought or wanted treatment but didn't get it.
Even if your analysis were solid, I find your conclusion somewhat cruel. Some might look at the same set of facts and think, "we need to figure out how better to help the people who have comorbid mental health and addiction disorders."
It's good to have someone with professional expertise commenting on this. Hopefully that expertise includes ground-level experience.
One important "confounding factor" that needs to be considered is that a hefty fraction of people addicted to hard drugs die young. Often very young. Lethal overdose is the problem that's most discussed, and the death toll from fentanyl has been particularly dramatic, but it isn't the only hazard of hard drug addiction. A sizeable fraction of people on dialysis are drug addicts, or former drug addicts. Dialysis is, tragically, an end-of-life support that often does not extend beyond 5 years. There are disabling impacts from nonlethal overdoses. Addiction plays havoc with nutrition, with desire to engage in physical activity, the immune system and neurochemical system. Needle use on the street or in the criminal subculture is fraught with health perils.
I don't know how much of the problem might be related to the iatrogenic effects of the Drug War, but while most alcoholics seem to make it to their 60s, a large number of opioid addicts don't make it out of their 20s, and many more don't make it as far as age 50.
It's frustrating to outsiders, because "confirmed addiction" is so resistant to intervention. But I think maybe the most important component is simply being out of the life and completely away from drugs for at least one year. Not that it's a guarantee, but many addicts haven't even had the opportunity. (Doing 30 day stretches in jails with a thriving drug trade is not the same thing.) Fentanyl is a particularly bad scene, because addicts live on a foreshortened horizon of their next fix to avoid coming down and getting sick, and with fentanyl that's only 4-6 hours.
I would say I'm pretty ground level - my work involves a lot of buprenorphine prescribing and conversations with people addicted to drugs or in recovery.
You're right that the morbidity of drug addiction matters as much as the mortality. Some drugs are particularly hard on the body, alcohol being the worst, but even relatively benign drugs can have devastating psychological consequences. Self-neglect is common.
This is another reason that I think approaching addiction as merely a question of preference fundamentally misunderstands the issue.
Also, yes. The best predictor of long term sobriety is (circularly) shorter term sobriety. This is where medical intervention can play a really important role. For example, my fentanyl addicted patient might eventually stop using on their own (if they don't die first), but treatment with opioid replacement can get them there much sooner.
My usual advice is to stick with buprenorphine for at least a year, and meanwhile people build relationships and obligations removed from the world of hard drug use.
What's the problem with visible tattoos? I hope it doesn't sound like an aggressive question. I'm genuinely curious.
Evidence of a short term mindset.
Tattoos are permanent, but few age well. They can’t really be removed.
Hilariously I think they are used as some sort of social status for the lower class (because they get crazy expensive very fast).
But yeah to me it sounds incredibly stupid to spend that much on something of no practical value that can only cause trouble latter.
If you want to burn cash, drugs are actually better because at least you’ll have fun for a bit…
Women encourage each other to get them. It sabotages their mate value.
Men do it to mark their affiliations.
that's a thought provoking observation.
Separating briefly the idea of being a raw utilitarian +/- from whether we should bite the bullet on allowing people freedom to do self destructive stuff…
It does seem like a negative EV decision to use drugs with modestly positive modal effects on wellbeing, such that even though most people are very modestly worse off by banning drugs, we’re in expectation better off as an average member of society.
There are probably some sub populations for which that’s not true. Like if we could restrict drug use to only high income households with stable family environments, we probably cut off much of the long tail of bad outcomes, but that doesn’t seem super politically feasible
The fact that drug use is concentrated among the young feels like not a favorable tilt as it relates to externalities. It would be far preferable that drug use were concentrated among elderly populations with fewer young children and spouses who suffered the collateral damage.
EV - electric vehicle? This stuff is hard enough without cryptic abbreviations.
I gave up on yours. Hope I didn't miss much.
I broadly agree that people shouldn't use random abbreviations, but in the comments section of an economics blog it's not crazy to think people will recognize Expected Value (EV).
Insiders will. The rest of us (MBA, CPA) are out in the cold, scratching our ...s.
The coterie will know. We unwashed have other blogs.
Astounding to hear that MBAs and CPAs aren't thinking about Expected Value often enough to have "negative EV decision" auto-update to "negative expected value decision" as soon as they see or hear it.
But yeah, broadly I'm totally in agreement that you shouldn't use acronyms unless they're first defined - it doesn't take many cases like this of failed communication to make the use of EV negative EV with respect to meaning communicated per word typed :p
I was actually bottom of my class at Wharton in '68, and just squeaked by with my CPA 5 years later with a 78 (75 to pass), so ...
I'm substandard - bottom of the barrel. I really shouldn't be trying to read difficult material like this. Back to network television for me. Give my feeble, old brain a much-needed rest.
The concept that most age out of addiction also supports the benefits of treating it as a “disease” and using medication assisted therapy such as suboxone or methadone, no? Or harm reduction approaches in general. You can remove the impulsive drive for the substance for several years until they age out and are no longer at risk of an overdose that
If you regard it as a self-limited disease, then you don’t necessarily have to offer treatment of any sort. Medical science is replete with “remedies” for things that get better without treatment.
But in the case of alcohol and opioids, there are now good treatments that absolutely work
Explain, please.
Buprenorphine is very effective for reducing overdose death and relapse from opioids. It is a partial agonist opioid with minimal euphoric or psychiatric side effects that is very hard to overdose on (maybe impossible)
Naltrexone and acamprosate are effective for reducing relapse on alcohol and heavy alcohol use. Other meds also have good evidence.
GLP-1 agonists (your ozempics, etc) are very promising for addiction disorders and trials are in progress.
Longitudinal or retrospective research from the 1980s and mid 2000s would not reflect how much the reality has changed over 20 years.
From a personal perspective, I have patients who would NOT have "aged out" who are functioning and working because of these therapies. I also have some that probably would have aged out.
I think the author was advocating more for an end to strict drug prohibition, which I heartily agree with. But the idea that treatment is useless is just untrue in 2025
Self-limited but with a serious risk of overdose, so the goal would be to minimize the risk of OD
Whose goal? I work on the theory that the person choosing to use drugs, however sourced, accepts the risk of doing so, and lives or dies with the consequences. I’m not convinced that “society” can make drug use safe, especially the illegal drugs. They are illegal because they are unsafe.
When made in a state of the art way they are not unsafe by themselves. They are juste easy to abuse. I mean the US had an opioid epidemic with very safe very legal drugs…
It’s the potential for abuse that is the danger and since it is wildly different for everyone but definitely much worse for weak people we prefer to ban them.
And being illegal it precisely when it becomes more unsafe. Because they’ll be sold by shady individuals that might have botched the work, cut it with dangerous stuff and just plain lie about what they are selling. There’s no quality control and no hygiene, it’s basically a gamble, even though in most case it’s not too bad (you have more chance to be scammed than anything else really).
But people still consume plenty of drugs, they just go see a doctor to get a prescription and voila, it’s legal.
The whole discourse around drugs is hilarious hypocrisy. It is first and foremost governments enforcing their monopolies on taxation (and violence).
If you get drugs in a sanctioned system where they can tax every single transaction they don’t care.
Another reason addicts stop using drugs is death. Did the studies factor death into the estimates of the share that recover/don't recover?
He did address that.
I missed it. Read the whole thing. Only drug-induced deaths count, of course.
Greetings Bryan,
I wanted to introduce myself, I’m Jordan and I write about History, I am an ex addict.
In my latest article, I talk about my drug issues and how I recovered, alongside some interesting aspects of history.
I wanted to drop a comment as it may help in your journey.
https://open.substack.com/pub/jordannuttall/p/real-monsters-in-tartaria?r=4f55i2&utm_medium=ios
There's a major problem with the study: it's lumping all the drugs together. I suppose I'll have to read the primary source to find the exact details.
Since the DSM considers "Cannabis Use Disorder" to be "drug dependency disorder" basedon fairly nebulous criteria, that potentially throws the study off the most. But even if cannabis were to be excluded, each substance deserves its own profile. The trajectory of dependency and duration of ongoing use are different for each substance.
No, the moral of the story is: don't categorize people as criminals from the moment of their first willing experimentation with restricted or prohibited mind-altering substances. Parental communication is not enabled by an official policy that officially ordains a child with Criminal status for ingesting a mind altering substance. Drug use is not inherently malum in se criminal behavior. Use of addictive drugs does not result in 100% of the user cohort being addicted to them, either. Not even a majority being addicted to them.
The supply should certainly be controlled by regulation and restriction--including prohibition, in some cases. But the bottom line is that mass criminalization has had a more profound impact on our society than mass incarceration, which has been only one of its consequences. For a population by definition involved in criminal activity, the question of whether or not someone has been arrested is less important than the question of whether they could be arrested for it. That's arguably the original Cancel Culture: America's mass cancellation of Dopers. And also introducing matters of Social Status Privilege into the mix. Including the subversion and inversion of that hierarchy. Infuriating, isn't it?
Do you realize that simple possession of alcohol was not a criminal offense in the 1920-1933 Alcohol Prohibition era? There were a few localities that had a possession offense on the books, but it was rarely enforced, and not with jail sentences.
This is a separate issue from the dysfunctional addict population on the streets, who commit actual malum in se* criminal offenses on the regular and who would benefit from a good solid year in a locked rehab facility like a tent camp in a jail that is competent enough to ENSURE that there is no drug use or drugs trade within the walls. An addicts only jail, for nonviolent offenders. And if they relapse into dysfunction and end up on the street again, they go in for another year of dryout time. (Choice posed to someone determined to go back to their habit again: either stay clean long enough to maintain a functional legal hustle, or go back to it immediately, get rousted, go into forced rehab again. Get a functional hustle, you might decide to hell with going back to drugs.)
[*Most of them admittedly petty, but still. And in this case, they have a way of adding up.]
Your Bet On It piece on aging out of drug addiction is a sharp take on how time and maturity can shift the tides of dependency, offering a hopeful lens on a tough journey. I leaned on marijuana for over a decade to manage chronic pain and break free from VA-prescribed opioids, but quit when it became too potent and riddled with untrustworthy pesticides and herbicides. The withdrawal unleashed a torrent of vivid dreams as my brain rebooted REM sleep, a raw shift I detailed in an article to guide others through recovery’s unexpected turns. Your point about aging bringing perspective resonates—sometimes it’s the years that teach us to choose ourselves over the haze. If my article strikes a chord, I’d be thrilled if you subscribed to my Substack for more recovery insights! Full article: https://sleuthfox.substack.com/p/want-your-dreams-back #AgingOut #SoberPerspective #RecoveryRoad #MarijuanaRecovery
Is it a felony for MIT duke UNC Chapel Hill et al to lie about the DOB and date of PhD 1988 like me to hide fact that pastrami face Ariely got burned in Beirutarch 8 1985 mossad attack?
You would be horrified if your kids tried climbing mountains? Why?
Typical outdoor sport rock climbing is 3 micromorts, 1 death per 320,000 climbs (UK HSE). Mountaineering is much more dangerous at 2800 micromorts per climb ( Matterhorn), and Everest is 38000. I'm guessing he's thinking of the latter.
That depends entirely on the mountain.
It is still a much more dangerous activity/sport than most things.
There are a lot more associated risks than you can find in more “typical” activities.