Hey, I think I may have asked you this before, but I have been wondering how you reconcile your views on addictions being mere preferences with the fact that I and thousands of others pay a decent amount of money for wegovy or ozempic. What do you think is happening?
Seconded. 1. Einstein paraphrased Schopenhauer as 'Man can indeed do what he wants, but he cannot want what he wants' but it seems: With *conflicting preferences* we can adjust their respective strengths: "Contingency management", sure. Public shaming might help, too. Or higher fees for health insurance. Nowadays: ozempic&co to switch off the preference for extra-calories. While stuff that did not help included "body-positivity" and campaigns against fat-shaming - or labeling addiction as a clear cut illness.
I would see Scott as a "winner" of that debate, but I wished there had been a better one between those two thinkers/blogger who both respect/like each other.
3. "preference" and "illness" are both terms not as clear or helpful as Caplan tends to pretend. I swear and I know; I want to be slim again. If saying No to this Lindt-chocolate would make me lose those 15 kg: I would throw it away. But the marginal joy of eating it is higher than the marginal weight I gain from it. So I eat it. ;) So, sure - "it is all preferences", but then - so what, mostly we can neither choose nor easily adjust those preferences. When we can, we often do. (There are still overweight people in the west, but injections of ozempic are not yet as cheap, nor easy to get, nor fun.) And then we often do not, and some nudging would seem a good choice.
Thank you! I've read some of Caplan's posts on addiction recently and found his conclusions perplexing to say the least. Seeing this history, it seems clear that he doesn't really want to engage in good faith on the topic of addiction. When challenged, he chooses an extremely broad definition of 'preference' that is inconsistent with the dictionary or colloquial one.
The second post by Scott Alexander sums up his evasiveness very well.
He reads like someone who took econ 101 and psych 101 at U Chicago during the peak of behaviorism, had his mind blown, and decided that rational choice theory explained everything.
As said, I agree with Scott more than with Caplan - but I agree with Caplan that the *consequences* should be LESS labeling bad behaviour as "disease" and more as "your sick preference" you shall ('shall' as in "East of Eden" and Genesis 4:7) work on or suffer. As this helps more to get people to adjust how they act on their 'preferences'. Which seems to some extent possible even with heroin addiction/some depressions/some schizophrenia.
Yes, the definition of disease is not always clear cut. Especially in psychiatry, but actually in lots of other medical fields, where patient reported symptoms and behavior make up a significant proportion of diagnosis or staging (ex. aortic stenosis, mild vs moderate vs severe). This makes diagnosis much more grey than many people realize.
Psych in particular should do a better job of framing some conditions as recoverable rather than manageable. With my patients, I try to do this.
Agency is important in many conditions, addiction in particular. Addiction medicine generally understands this well, so do most people with addiction. When my patients relapse, they don't say "oh well my disease caused that," they feel terrible and guilty. We plan for how to interrupt the circumstances of the relapse in the future.
I do not understand how framing addiction, schizophrenia, or any condition in terms of sick preferences is particularly helpful. The sick preferences ARE the disease. That's the whole issue.
That a behavior responds to incentives is beside the point.
Let's say I'm addicted to fentanyl. I need to use it at least 6 times a day to stave off withdrawal. I hate being addicted, I hate fentanyl, I hate almost dying from accidental overdose. You may be able to get me to stop by offering me $100,000 or kidnapping my children.
The relevant issue is WHY some people would need to have a gun to their head to stop doing something they hate in the first place Why then would that person be at a higher risk to go and do that whole thing over again?
Paraphrasing Scott, being addicted to drugs in a life ruining way has a constituency of zero.
My problem with Caplan is that his "solution" seems to be "let them overdose, ruin their lives and die if they want to."
Meanwhile, we're over here helping people recover.
I think if Bryan Caplan spent a year hopelessly addicted to fentanyl or worked in a psychiatric inpatient unit for a month, he'd realize how divorced from reality his prescriptions are.
People pursue other self-help strategies too. Like to ensure they don't overeat oreos, they don't buy any, because it's easier to not buy the box at the store than to not eat the whole box at home. If people's preferences are consistent and addiction is fake, you wouldn't see people doing that. You'd see them plan out their oreo consumption to more evenly space it between grocery trips.
Yeah, but those mostly don't work. If I understand Bryan's views correctly, the fact that they do such things even as they don't work shows only that they are trying to convince others they want to lose weight but can't, when the rality is that they are not willing to lose weight if it means eating less.
Ozempic, however, does work. So I was curious about what he thought
I personally can use small tricks like that to change my behaviour. Another example would be there's an app called Focus Friend, where you set a timer to dedicate yourself to work for some period of time. Just setting the timer in an app dedicated to focusing has been able to get me to change my behaviour and actually get more work done.
Lol. And one can get it much cheaper. I would buy for that price. Just a hassle: I need an address In Hungary as they will not deliver to other countries in Europe.. https://www.cremieux.xyz/p/how-to-get-cheap-ozempic
Last I checked food cost money. Those who eat more already pay more.
Very few people were overweight when 40% of the average income went toward food (just a few generations ago!).
I guess the question is *how much* more. I don't think you could get Bill Gates or Elon Musk to quit something by paying them $50 each time they don't consume.
There is a natural experiment here. If you were to try cocaine daily for several months, and then see if you were able to quit without any outside assistance.
MOST addicts eventually quit. Without outside assistance. Something over 90% of soldiers who used hard drugs in Vietnam stopped using when they returned home.
Almost anything is fairly easy to quit if it's done with a very slow taper. Those who stay lifelong users generally...want to be that.
Hey, I think I may have asked you this before, but I have been wondering how you reconcile your views on addictions being mere preferences with the fact that I and thousands of others pay a decent amount of money for wegovy or ozempic. What do you think is happening?
Seconded. 1. Einstein paraphrased Schopenhauer as 'Man can indeed do what he wants, but he cannot want what he wants' but it seems: With *conflicting preferences* we can adjust their respective strengths: "Contingency management", sure. Public shaming might help, too. Or higher fees for health insurance. Nowadays: ozempic&co to switch off the preference for extra-calories. While stuff that did not help included "body-positivity" and campaigns against fat-shaming - or labeling addiction as a clear cut illness.
2. Now there was a looong argument between Caplan and Scott Alexander (MD, psychiatry) whether to see laziness, alcoholism, depression, schizoid behaviour etc. as illness or preference. https://slatestarcodex.com/2020/01/15/contra-contra-contra-caplan-on-psych/ (links in the beginning) and the kinda bitter: https://www.astralcodexten.com/p/sure-whatever-lets-try-another-contra
I would see Scott as a "winner" of that debate, but I wished there had been a better one between those two thinkers/blogger who both respect/like each other.
3. "preference" and "illness" are both terms not as clear or helpful as Caplan tends to pretend. I swear and I know; I want to be slim again. If saying No to this Lindt-chocolate would make me lose those 15 kg: I would throw it away. But the marginal joy of eating it is higher than the marginal weight I gain from it. So I eat it. ;) So, sure - "it is all preferences", but then - so what, mostly we can neither choose nor easily adjust those preferences. When we can, we often do. (There are still overweight people in the west, but injections of ozempic are not yet as cheap, nor easy to get, nor fun.) And then we often do not, and some nudging would seem a good choice.
Thank you! I've read some of Caplan's posts on addiction recently and found his conclusions perplexing to say the least. Seeing this history, it seems clear that he doesn't really want to engage in good faith on the topic of addiction. When challenged, he chooses an extremely broad definition of 'preference' that is inconsistent with the dictionary or colloquial one.
The second post by Scott Alexander sums up his evasiveness very well.
He reads like someone who took econ 101 and psych 101 at U Chicago during the peak of behaviorism, had his mind blown, and decided that rational choice theory explained everything.
Welcome, as an extra one more old Scott-post about how to define "disease" ;) https://www.lesswrong.com/posts/895quRDaK6gR2rM82/diseased-thinking-dissolving-questions-about-disease (So Scott is very well aware that lots of 'diseases' are not clear cut, but in the debate he focused too much on attacking Caplan's concept of "preference".)
As said, I agree with Scott more than with Caplan - but I agree with Caplan that the *consequences* should be LESS labeling bad behaviour as "disease" and more as "your sick preference" you shall ('shall' as in "East of Eden" and Genesis 4:7) work on or suffer. As this helps more to get people to adjust how they act on their 'preferences'. Which seems to some extent possible even with heroin addiction/some depressions/some schizophrenia.
As a Scott-fan, I add one more newer post, but one should read the Caplan-posts, too. He takes a lot of inspiration from Szasz. https://www.astralcodexten.com/p/you-dont-want-a-purely-biological
Yes, the definition of disease is not always clear cut. Especially in psychiatry, but actually in lots of other medical fields, where patient reported symptoms and behavior make up a significant proportion of diagnosis or staging (ex. aortic stenosis, mild vs moderate vs severe). This makes diagnosis much more grey than many people realize.
Psych in particular should do a better job of framing some conditions as recoverable rather than manageable. With my patients, I try to do this.
Agency is important in many conditions, addiction in particular. Addiction medicine generally understands this well, so do most people with addiction. When my patients relapse, they don't say "oh well my disease caused that," they feel terrible and guilty. We plan for how to interrupt the circumstances of the relapse in the future.
I do not understand how framing addiction, schizophrenia, or any condition in terms of sick preferences is particularly helpful. The sick preferences ARE the disease. That's the whole issue.
That a behavior responds to incentives is beside the point.
Let's say I'm addicted to fentanyl. I need to use it at least 6 times a day to stave off withdrawal. I hate being addicted, I hate fentanyl, I hate almost dying from accidental overdose. You may be able to get me to stop by offering me $100,000 or kidnapping my children.
The relevant issue is WHY some people would need to have a gun to their head to stop doing something they hate in the first place Why then would that person be at a higher risk to go and do that whole thing over again?
Paraphrasing Scott, being addicted to drugs in a life ruining way has a constituency of zero.
My problem with Caplan is that his "solution" seems to be "let them overdose, ruin their lives and die if they want to."
Meanwhile, we're over here helping people recover.
I think if Bryan Caplan spent a year hopelessly addicted to fentanyl or worked in a psychiatric inpatient unit for a month, he'd realize how divorced from reality his prescriptions are.
People pursue other self-help strategies too. Like to ensure they don't overeat oreos, they don't buy any, because it's easier to not buy the box at the store than to not eat the whole box at home. If people's preferences are consistent and addiction is fake, you wouldn't see people doing that. You'd see them plan out their oreo consumption to more evenly space it between grocery trips.
Yeah, but those mostly don't work. If I understand Bryan's views correctly, the fact that they do such things even as they don't work shows only that they are trying to convince others they want to lose weight but can't, when the rality is that they are not willing to lose weight if it means eating less.
Ozempic, however, does work. So I was curious about what he thought
I personally can use small tricks like that to change my behaviour. Another example would be there's an app called Focus Friend, where you set a timer to dedicate yourself to work for some period of time. Just setting the timer in an app dedicated to focusing has been able to get me to change my behaviour and actually get more work done.
Some people benefit from strategies like that, but overall extremely few things reliably help people lose weight - basically surgery and semaglutide.
That’s a good point. I wonder if anyone has done studies on paying people to eat less
If you pay enough often enough, it has to have real effects.
Studies are needed to find how much.
I wonder if it's less than people pay for Ozempic?
Lol. And one can get it much cheaper. I would buy for that price. Just a hassle: I need an address In Hungary as they will not deliver to other countries in Europe.. https://www.cremieux.xyz/p/how-to-get-cheap-ozempic
Last I checked food cost money. Those who eat more already pay more.
Very few people were overweight when 40% of the average income went toward food (just a few generations ago!).
I guess the question is *how much* more. I don't think you could get Bill Gates or Elon Musk to quit something by paying them $50 each time they don't consume.
Drugs cost money too and a cocaine habit costs much more than an overeating habit
Addiction is a lifestyle "choice," like poverty: that is, kind of. Sometimes (often?). To an extent. In many cases. DEFINITELY maybe. In some ways.
2005 was 20 years ago. Thanks for the depressing reminder
There is a natural experiment here. If you were to try cocaine daily for several months, and then see if you were able to quit without any outside assistance.
<-volunteer
MOST addicts eventually quit. Without outside assistance. Something over 90% of soldiers who used hard drugs in Vietnam stopped using when they returned home.
Almost anything is fairly easy to quit if it's done with a very slow taper. Those who stay lifelong users generally...want to be that.
Or just nicotine for something less extreme.