Appendices: "Some Observations on Alcoholism"

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Author’s Note: This post is a response to an earlier post of mine. For some context on this post’s “appendices” format, read this Appendix.

This post is in part a response to my earlier post on alcoholism, but is largely made of lots of different newish points about addiction. It is the final draft of one of the posts I made for Draft Amnesty Week. I made moderate changes to most sections, but the biggest change is I just have a ton more content now. 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.

In my draft amnesty post, I mentioned a few additions I might make. I wound up only adding the section on philosophical positions common in EA and inconvenient to recovery. I also added a section explaining why I am now a teetotaler, and considerably expanded the section on kratom. I wrote the response to Ozy Brennan’s sex addiction post I mentioned, but wound up making it its own post. I mostly skipped the broader policy pet peeve I mentioned, except implicitly mentioning it in a footnote (I may or may not write this as its own post at some point, and I already discussed something like it a bit in the beginning of my post on suicide). I also skipped writing a section on medical options, in large part because the combination of my original post and the Lorien Psychiatry page already cover most of what I would say. I will however briefly mention that there are exciting upcoming developments in this field which a recently launched EA group is trying to promote.

Also, worth having a content warning of some kind here, this post gets into some unpleasant territory (though often briefly) - addiction, relapse, self-harm, suicidal thoughts, strained family relationships, unemployment, the works. Especially Appendix A which is also quite personal, but to an extent also Appendices E and F, and a couple of the footnotes. Feel free to sit this one out, or at least Appendix A.

Thanks to the EA forum, my sister, my Discord pal Leo, Nick as always, Nicholas from Curing Addiction, and miscellaneous others, for the helpful feedback/consultation for this piece.

Appendix A: the Personal Stuff

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 (subsequent testing has shown the development of chronic gastritis, most likely with some bleeding out), 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 in a drunk episode involving 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 have now been sober for a little over three months, 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, I’m sober longer than I’ve ever been since this whole thing started, and I am in an outpatient program and going to groups nearly every night. I am not sure this is the end of the road, but I’m in a better position to end this than I ever have been before. I was optimistic when I wrote this article, but I haven’t been optimistic again since then, not even really in rehab. I am optimistic again now, and I think it is more rational than the last time I felt this way.

Appendix B: Meet the Meetings

In my original post, I didn’t discuss recovery groups. I hadn’t been to any other than one my school’s health center ran, 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 (like the one focused on Effective Altruists, linked at the top of this post). 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, Recovery Dharma, and SMART Recovery. Out of these, I find SMART to be the best personal fit, and sort of suspect this will be true for most EAs. 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 cultishness, 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 some of the other stuff if you want to, but the actual important thing is always doing AA. This tends to come with a sort of smug “oh I once was like you” tone when you raise objections or talk about things you plan to do differently from the AA norm.

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 cultish 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 for, and moving past them. I think this is very important, because many addicts find themselves engaging in many behaviors they would have, 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 cultish, 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 can be 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 1. 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.

In the initial draft I more or less left things there when discussing the “gamification”, in no small part because I was worried the AA stuff was getting too long. Further thinking as well as subsequent feedback on the draft has made it clear to me that I should also talk about the not-inconsiderable downside of this.

The gamification helps with avoiding relapse in important ways, but boy does it put you at risk if you do relapse. If someone loses all their progress when they lapse, then they might as well go in for a full blown relapse. Part of this can be the blow to their self-confidence or self esteem, but part of it is also that you lose all of your days in one day when you are counting days, and after you lose all of your days, you aren’t losing any days again until you stop drinking. It’s easier to justify drinking more, in part because of the sense that you have less to lose now, in part out of fear that if you don’t get it out of your system now, you’ll drink again when it really counts (you know, when you’re counting days), and in part because of the blow to your confidence in the sense that you are right back where you started.

Not only do you need to start counting days all over again, you have to start the steps all over again. This, speaking of ways AA can exaggerate its effectiveness to itself, means that having more steps isn’t just a proxy for how committed to the program you are, but also for just how long you have made it sober so far (which improves your odds of making it further still). Things like this are a big part of the reason SMART recovery is much warier of day counting and concrete sequential steps.

In fact SMART 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 likes 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 often 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 more like a magnet in your head pulling towards one set of thoughts/solutions, which it takes active effort to move away from and is still there when you tire out. Not something anthropomorphic enough to effectively get angry at.

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, the ones I attended had 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: Weed, and the Shallowness of Withdrawal

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 to sixth most common addiction I see (after alcohol, nicotine, and cocaine, and somewhere close to opiates and crystal meth). 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 idea 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 the 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 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 can access their services (or at least assume that you have). 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 weed 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 (very easy to convince yourself one of the two applies on any given day), 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. 2

Appendix D: Kratom Mythology, and a Generous Scoop of Footnotes

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 that common an addiction, I only know two people addicted to it. As far as I can tell though, 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.

I’m not totally sure where this myth came from, but there are a few possibilities. For one thing, while it’s outlawed in a few states, it’s not really federally regulated once it’s inside the country at all, either as a drug or a food, so the labeling doesn’t have to contain any warnings. Relatedly, while it was almost federally listed as schedule 1, it ultimately wasn’t scheduled at all. As far as I can tell, this was the right decision. I wish kratom was better regulated, but in case this seems unclear from the rest of my writing in this piece, I am opposed to outlawing most drugs. I am not certain if or where exceptions to this general leaning of mine should be – heroin and crystal meth are examples of extremely addictive substances which there is a limited market for (in no small part because of this). I am very sympathetic to the idea that the benefit of outlawing these is worth the costs, but truth be told this has so far paid off in a ton of adulteration with even more dangerous substances like fentanyl or xylazine. If tests strips were better advertised and distributed, 3 and maybe gave more fine grained information about amounts of contamination and not just presence, I might be able to make a better judgement on this issue.

Kratom at least seems unlikely to me to be worth outlawing. The issue is, lots of arguably even more innocuous substances like weed and shrooms are currently widely illegal, which I think gives some people the vague impression that kratom must be even more innocuous than these 4. I think something similar has happened with alcohol. This impression is further vindicated by the places it is sold. From my readings it seems as though it’s often sold at “Kava Bars”, which specialize in the more innocuous substance kava. In my area the place I most often see it advertised is in smoke shops, which mostly sell things like Delta-8. 5

The situation is further complicated by the lack of rigorous evidence about it compared to other drugs on the market – I can say from the people I know that it is fully addictive, but I can’t give a good explanation of how bad it is overall. 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.

There are wildly different anecdotal accounts of how bad it is, though. Some users claim it is no more affecting than coffee. My sister disagrees, and really hates the stuff. In part because of the factors I’ve just discussed which cause it to be more normalized than other drugs, but in part because she feels that it significantly reduces empathy in ways that make subtle differences because of the lack of immediate impact on other aspects of personality (I am somewhat tempted to dismiss this based on others I’ve talked to, but she has tried it herself, knows a couple of kratom addicts personally, and has also tried more conventional hard drugs before).

At the very least it seems like it could be valuable to some people in withdrawal from things like heroin who are unable or unwilling to access things like methadone or buprenorphine. I am much more torn about people who use it for chronic pain, but suspect it is worth it for at least some people in this situation (but not most people). However I would be very careful thinking about it in recreational contexts, like as an alternative to alcohol. I probably recommend it over alcohol, for the withdrawal if nothing else, but it isn’t some innocuous non-addictive alternative.

Appendix E: The Inconsolation of Philosophy, and Being a Grown Child

In my original post I discussed a few beliefs that in some way either made me more likely to drink (x-risk worries) or made my drinking feel worse (demanding ethics of beneficence) associated in some way with Effective Altruism. There are some other philosophical positions I haven’t discussed yet, however, which are often more common amongst EAs than outside of EA and which have also given me difficulty in recovery. These are often views that I have had to almost pretend I don’t hold, or lean into the part of myself that intuitively disbelieves them (or at least recognize this part of myself). Other times they are basically impossible to just pretend don’t exist to the needed extent.

The most obvious one is probably atheism. This is inconvenient for the fairly specific reason that it makes me fit in even worse with the AA program – the most readily available recovery group, and the one easiest to talk with and get advice from other alcoholics about. Beyond this social inconvenience, I think AA has been popular in part because of the benefits of involving religion of some sort in one’s recovery, not just vice versa. In Appendix B, I described the basic features of “God” that seem important to working AA normally in the following way:

“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”.

It can be genuinely valuable to have something like this, especially if it is always around, so you can’t ever “get away with” drinking. Even better if it also accounts for the bad things that happen to you. This last one is very weird and hard for me to relate to, but so many addicts in my programs seem to get value from reframing bad things that happen to them and trigger them as “tests”. Things they are given by a benevolent deity because they are meant to be able to get past it and prove something in the process, and which will later pay off in some karmically positive way. I don’t have this. I am not just “an atheist”, I am the wrong sort of atheist. I have difficulty answering people when they ask whether I am “spiritual”, because I feel that this question pays off in a couple different ways.

If I describe my metaphysical views to people, I think they automatically consider them a bit “spiritual”. I believe that there are no hard boundaries between different people, and that in some sense therefore, acting with altruism and acting with prudence aren’t separated by anything metaphysically meaningful either. I believe that there is some “mind” in everything in the universe, and further lean towards the belief that mind is something like the intrinsic nature of all matter. This all sounds very woo and spiritual in “genre”. More substantially it has connection to “Eastern” ideas, in at least the sense that they are closer to the views endorsed by many Buddhists than those of most members of Abrahamic religions (and “Eastern” is practically a synonym to “spiritual” in many Western minds).

The issue is, as far as I can tell “spirituality” gets to ideas like these from a sort of overfitting of human cognition with the rest of the universe. Self-described “spiritual” people will often believe in forms of psychic connection with facts about the universe far away, or past lives or future lives, or will believe in some sort of cosmic intentionality, or universal moral balance. A beneficence basic to the universe. I came to my beliefs in a very different way. I decided that the sorts of things that people associate with individual human minds, unified wills and intentions, integration of the information within the “mind”, are all loosely defined concepts that break down as differences of kind when certain mental facts are merely changed by degrees. That is, the universe having a mind doesn’t mean that it has human-like attributes; rather, I think that the universe doesn’t have to have remotely humanlike characteristics to be a mind, and this is why I can still believe that it is one. I think that the universe is neither coordinated nor integrated in ways that interestingly resemble the human mind or are close to what we even mean by words like “value” and “meaning”.

Beyond even just AA and “god”, spirituality is an extremely popular angle for recovery work, and the psychological benefits of “spirituality” were extolled numerous times while I was in rehab, especially through the work of Lisa Miller. I do care about things like morality and altruism a great deal, and participate in a social community that shares similar reasons for and approaches to these things, and I think this gets me some of the relevant benefits. However, I think both that existing resources would be of more use to me, and that even in an ideal world I would have more and better choices for my recovery, if I was “religious” or at least “spiritual” in the relevant senses.

There are less obvious issues as well, though. In my original forum post, I make reference to “some recent more hard to explain emotional motivation”. This was mainly a reference to a single weird, hard to explain event that gave me a burst of motivation. Maybe it’s reflective of my general weird psychology and the type of media that sometimes affects me a really unusual amount (and part of the reason I was reluctant to write about the experience directly), but it happened in the middle of watching Toy Story 2.

I hadn’t watched it since I was young, well over a decade ago, and I decided it might be something fun and nostalgic that I could reserve as an incentive for a night I managed to stay sober. This was following up on several straight days of heavy drinking and a sense of defeat in a plan I had recently been meaning to implement after successfully tapering. That day I got sick of the motivational failure and took naltrexone to ensure that I didn’t have much incentive to drink.

I thought the movie would be a fun distraction, but as I kept watching it I was getting unexplainably sadder and sadder, and almost turned it off. Eventually it got to probably its most famous sequence, Jesse’s backstory and the accompanying song “When She Loved Me”. I started bawling, which in itself isn’t exactly surprising or difficult to admit, it is one of the many Pixar scenes that are basically precision engineered for clickbait listicles about things that make zillenials cry. But I don’t think this was a normal reaction to the scene, or simple nostalgia. I wound up immediately connecting it to my alcoholism, and in particular where I was now versus who I was as a child.

Part of this was probably as simple as the fact that that was the last time I watched the film, but there were also more direct connections in the scene, such as the sense of betrayal in the child growing up and losing values once important to him, or the sadness of observing this transformation from the perspective of someone who deeply and originally cared about this child. I of course don’t think that Pixar meant to imply that getting into makeup and playing less with cowboy toys is a moral failing, but of course when I watched the scene as a child I viewed this scene as the sort of abject betrayal I, of course, would never do. Funny that I felt worse about my drinking when I thought of it as comparable to abandoning Jesse than when I thought about it as, well, the life ruining actual real thing that was happening to me and those close to me. I’m not sure whether that says something about how affecting I find media like this in certain moods, or just the way alcoholism itself resists being looked at directly.

It’s hard to explain exactly what I felt, but I wound up later interpreting it as mostly coming down to “what would my self as a child think if they saw me now” or the more bitter followup thought “what if this child knew that this is what they would be forced to go through, what they would be forced to become”. This seemed to tread the very difficult line recovering addicts often face. On the one hand many addicts report only being reliably motivated when they are doing recovery for themselves, not for others. On the other hand many have lost their sense of self and see themself now mostly as an addict, willing to sacrifice all other values and whose personality is defined by either getting a drug or being on it. In short, someone who even the most theoretically omnibenevolent person will have a hard time loving enough to go through the enormous effort required by recovery. Instead of falling on either horn of this dilemma, do it for your child self, because you are doing this to their life.

Now this is, in its way, a lovely sentiment, and one that was extremely affecting at the time and motivated me enough to get the optimistic period I was in when I released my original post. The issue is that I doubly, perhaps triply, don’t believe the basic philosophical assumptions behind it.

Most obviously, as I mentioned when discussing my strange relationship with “spirituality”, I don’t believe there are strong metaphysical boundaries between persons. I believe that the things I might appeal to about a future experience in order to label it “mine” rather than anyone else’s, will all come in degrees and be separated at arbitrary points, much like most of our practically useful but simplifying categorical language. In this way, it’s hard for me to say that I am now what happens to my childhood self in a sense that will be satisfyingly literal. In fact, the degree to which I am separated from what my childhood self would want, partially corresponds to the degree to which I am further from being straightforwardly “the same person” as this earlier self. I am tempted to view this as a wrong takeaway, by saying that there is no reason to use reductionism to put up boundaries, only to take them away, but as I’ve mentioned, part of what is useful about this connection to my recovery is the sense of “doing this for myself”. Reductionism concerning personal identity undermines the very idea of there being a difference here, and unfortunately dilutes the takeaway to a degree that is hard to remain viscerally motivated by.

It might still be possible to rescue the idea that I am “doing this to” the person I was as a child by appealing to the idea that this child had values about who I am now that I am betraying by my actions. Indeed very deep values, that ground some of this child’s own sense of identity, since he did not believe in reductionism concerning personal identity. The trouble is… I also disagree with value theories that say that the distant fulfillment of preferences can be good for someone. I do not think that if I have a preference now about things that happen in the future, and then the thing happens, it then retroactively benefits me. I think the value of my life then was sealed by the actual experiences I had at that point (this is a point I would have been in some agreement with even at the time, so it might be even more undermining than the personal identity concern, though I am also much more uncertain about this one).

I said possibly triply, because as I child I believed in A-theory time (not that I knew what it was called or extensively considered the alternatives, it was just the commonsense that I accepted), and it would have been sensible, and personally important to me, that I would become this future person. I no longer believe in A-theory time, so the most I could say, if I granted personal identity, is that this child would have to share an identity with a person experiencing the lows of addiction, at some different point in time, one forever separated from the child of the time.

I could still try to translate each of these components into ideas more philosophically credible to my present self: I currently care about what this other being (child me) would think about current me’s life. This being would have, to my current estimation, been distressed and hurt by the thought of this experience, on a deeply personal level. Therefore I, in the present, care about getting past my alcoholism. This is valuable, because I care about it right now, and recovery can happen to the me of right now.

This translation blows. It does absolutely nothing for me, in contrast to the initial thought itself. I don’t know whether my philosophical commitments did eventually cause my motivation to lapse, but lapse it has, and it’s been an uphill battle to try returning to this earlier state, and to basically just ignore the philosophy. Take this as a recommendation that something like that thought, that yourself as a child has to become the person you are now, and have the things that have happened to you happen to them, is a thought which can be highly motivating (and, fair warning, also extremely sad if you succeed in feeling it on a literal level). But keeping it might be especially difficult for EAs, who are more likely than most to have similar philosophical commitments to the ones I just mentioned.

A final, very subtle, difficulty I’ve had related to my philosophical beliefs, is about the point mentioned above when you become “someone who even the most theoretically omnibenevolent person will have a hard time loving enough to go through the enormous effort required by recovery”. Many people have a hard time believing they are worth the trouble to save, but they believe this more explicitly. They have done terrible, selfish things, and the process for being worth saving is relatively clear: you have to like yourself better - both by being more self-forgiving, and becoming a better person.

I have often had difficulty recognizing anything like self-esteem issues, because on paper I simply don’t believe in desert – I think morality in fact should be fully omnibenevolent. This means if people ask me if I think poorly of myself, my easy answer is “no, I don’t think poorly of anyone”. This is a lie in some relevant sense. I have human psychology, and with it, human problems with self-esteem, that are very difficult for me to introspectively identify. But I can identify that I would put in much more effort to save someone I love and admire from something like addiction, like immediate family members and close friends, than I have been willing to put into saving myself from it. Because of my philosophical beliefs, I haven’t found it as obvious as other people might that an important part of recovering means tending to my character and self-esteem.

You might notice the distance between the problem with the philosophical belief just mentioned, and the ones immediately before it. While I am both an intuitive and philosophical atheist, there is tension between my philosophical views and intuitions in the other mentioned areas. You can’t fully commit to whichever view is most helpful for recovery, without having the other side. If either the intuition or the philosophical belief is missing, it can make recovery that much more complicated in that area, and EA is a culture where people are unusually likely to accept philosophical beliefs that are in tension with intuition.

Appendix F: My Turn Against Alcohol

In my first blog post, I gave my quick review of the idea that we should increase regulation of alcohol, and socially discourge the drinking of it, as for instance advocated by Tyler Cowen. Overall I wasn’t super confident in this part, but said that I continued to lean away from positions like his. In my initial draft of this post, I briefly talked about changing my mind on this matter. Subsequent feedback made I clear to me that many people would have preferred more discussion/explanation of this. I’m a little hesitant to say too much here, the view was included less because I felt I had a blog-worthy rigorous take in the other direction now, and more because the relevant section was dedicated to updates in my situation that might cast a different light on my original post.

You can find some of my conversation on this subject in the comments section of the draft amnesty post, but I can try to summarize what I say there a bit/add a little, to hopefully provide a more satisfying treatment of the topic. My opinion on the matter hasn’t changed all that dramatically despite initial appearances. I remain pretty unmoved one way or another on regulations for example – I think more sin taxes/regulations on alcohol might be good or might be bad. I’m not sure. I think that alcohol genuinely has some non-trivial positives in a way that things like tobacco don’t, and I also still agree with my initial article that alcohol could well be a net positive for most people who use it. However, in my initial post I say,

“It is likely that those who have an unhealthy relationship with alcohol have a more dramatically bad one than the good experiences are dramatically good, but given the difference in numbers I don’t want to get ahead of myself on the aggregates, and overall I hesitate to recommend that people disappear alcohol from many public rituals.”

Uh… I feel I have a better idea of the aggregates now, and they are grim. While rates in Asia, South America, and Africa tend to be lower, Europe and North America have especially bad rates of alcoholism. My country, the US, is over 1 in 10 people, and in the worst performing country, Hungary, more than a third of all men have struggled with AUD (Alcohol Use Disorder), and nearly a quarter of the population in general. It is rare to find a country with a rate much below 1/20, and none of this is adjusting for the prevalence of alcohol use itself. The best performing countries tend to be majority Muslim, and even in the US over a third of the population doesn’t drink (though some portion of these people will be former drinkers who have struggled with AUD in the past).

Having struggled with alcoholism myself, I am very doubtful the aggregates are favorable. If you go out to drink casually sometimes, you will most likely have a good experience overall – some negative health effects, but for moderate drinkers nothing catastrophic. However you will be rolling some pretty grim dice by getting started. The odds aren’t much different from the five year mortality rate of breast cancer in the US, and the consequences if you get a bad roll are catastrophic for your relationships, finances, mental health, physical health, sense of self, career, and almost anything else you could think of.

And no one ever hands you a diploma to say it’s over. You never get to become an alcoholism alumnus. I know people who relapsed after decades. I’ve heard qualifications from people who had less time sober this time around than they had before their last relapse. Someone being at the stand and talking about how they got through alcoholism does not mean someone who has actually made it.

I remember in my last day in detox, hearing everyone go around the room to share their stories during a meeting, and this hit me like a ton of bricks. Most people there had tried over and over again and at some point had decent sober time before falling right back. Some had spent most of their lives trying and failing, over and over again, to stay sober. People had become parents, then grandparents, and were still coming back - even the young people were old, aging well beyond their years. I don’t think I’ve ever cried like that before, I was afraid they wouldn’t let me out because my blood pressure wouldn’t go down. It. Doesn’t. End. A nontrivial portion of the people I’ve met who have managed to get real time under their belts only did so because they almost committed suicide first, and decided, not unreasonably, that if they ever picked up a drink again, they wouldn’t make it out alive. Some of course didn’t make it out alive and just did kill themselves, and of course, as I’ve covered, that time under your belt is no guarantee.

None of this is universal, and I’m more optimistic than this lets on, but I’m not sure what number I could put on the risk of winding up here that would make the upside worth it (especially considering that the more I have to lose by stopping, the worse my odds are already). One in a thousand? Maybe one in a hundred if I’m feeling foolhardy? I don’t know specifically, but not the sort of odds that are realistic for most people a priori.

You can manipulate your odds by noticing that you are not merely a statistically average person. Women for instance tend to have better odds than men (but frankly still not good odds, especially in the US). You can also rule out certain risk factors, for instance family history increases your risk, so you are at somewhat less risk if you don’t have family history of addiction.

I notice, however, that people are rarely interested in adjusting in the opposite direction. How many people decide not to drink because, if you’re a statistically average man in the US, you have nearly a 1 in 5 chance of becoming an alcoholic? Or what about noticing the fact that you are drinking at all, as mentioned previously, you need to adjust for the fact that many people in these polls don’t drink in the first place!

I also notice just how often people I have talked to about risk are appealing to much less objective criteria like “I don’t have an addictive personality”, or how many alcoholics I know who were in denial about it for decades. In general this is an area where the more at risk you are of having or developing a problem, the more at risk you are of thinking about your risk unclearly. Most people would benefit from considering themselves more statistically average than they intuit they are, and the odds here just look bad.

I now tentatively endorse Tyler Cowen’s teetotalling conclusions – most people simply should not drink in the first place. This is a big step however, I will be very happy if I can just convince European and North American men with family history of addiction not to drink, or if I can convince adults to have literally a single popular group pastime in the evenings that does not involve alcohol by default 6. For god’s sake, there is so much room for improvement, I’m reluctant to even bring up my strongest recommendation on this.

Finally, in my original blog post I said,

“it is possible this is just my bias against social conservatism and paternalism generally”

and I kind of wish I had paid more attention to this worry when deciding to write what I did at all. Despite having some bias from personal experience, I think I also have significant bias in the opposite direction from my current view. When I hear many people in recovery spaces talk about alcohol, even people I don’t think are outright teetotalers, sometimes they say naturalistic scoldy stuff about drinking that really makes me cringe. People will write off any pleasure you get from drinking as though it is totally phony and irrelevant. I do not believe this, there are a wide array of options for genuine pleasures out there, pleasure that means something to your life, but alcohol is, as a matter of fact, at least one of them. As are many drugs I think it is inadvisable to use. Others will write off social interactions that involve alcohol. While I think friendships entirely mediated by alcohol are quite fragile, and quite dangerous, I don’t think positive social interactions, or the relationships that come from them, suddenly become fake because you have temporarily made yourself a bit stupider and looser in the tongue. There are versions of this that can make for fake relationships, but phoniness isn’t just inherent to meeting people while drunk.

More broadly, the idea of psychoactive drugs has deeply appealed to me since I was young, even though for this whole time I’ve worried about their effects in practice. We live once (modulo my current views on personal identity), and the idea that our life is more fake if, among the many different forms of life we experience, some are different in these especially psychologically unique ways, has always seemed like harmful dogma. Let us try a thousand versions of our minds on in our short lives. Just as we lead better lives if we study many different ideas, go many different places, meet many different people, and change and grow as people ourselves. These thoughts have all disposed me to be more positive towards drugs and alcohol than many more traditionalist types. To be more defensive. But noticing bad objections and tragic losses doesn’t change the bitter overall truth that drugs in anything like the currently available forms are on average a mixed to very negative bag. They provide some of this genuine psychological good to a life… alongside life-ruining, meaning-ruining consequences.

I suppose I feel similarly about drugs as I do about AI. I feel some visceral partisan defensiveness against the bioconservative naturalistic enemies of the good and beautiful in possible new forms of life, and continue to yearn for a psychonaut transhumanist post-scarcity fully automated luxury communist future… but we are extremely extremely unprepared, and I need to set my partisan leanings aside because Jesus Christ we’re in the middle of an emergency caused by how shitty we are at any of this stuff right now.

I don’t want to be overconfident here and dismiss all drugs as a bad idea, even the ones discussed here – I remain ambivalent on marijuana for instance, and I’m not that familiar with kava but my initial impression is that it isn’t a huge deal. I’m also ambivalent about (recreational) psychedelic use. I do meet psychedelic addicts, especially (debatably psychedelic) ketamine, but it isn’t particularly common and many people get experiences they report as uniquely meaningful from occasional use. But I think it’s possible to not be a bioconservative anti-fun scold while still leaning in the same direction as them away from current cultural trends on this topic. And that is where, I’m afraid, I now believe we ought to go with alcohol.

  1. 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 I hate headaches so much, wouldn’t it just be easier to do nothing?” “Just let me sleep/scroll a bit longer, maybe I’ll do it tomorrow” I’ve been told by a friend who has struggled with suicide ideation that something like this worked well for them as well. Nothing wrong (short term) with the lazy strategy if it helps. ↩︎

  2. Ed. Note (All “Ed. Note” footnotes are Nicholas Kross, to clarify.): I’ve dealt with other mental health difficulties in the past, and I’m here to make a tangential-yet-contextually-useful point: Some people/communities/media seem to tacitly encourage non-medical interventions first, including self-medication. The (kinda-strawman) right-wing version is something like “this is a character flaw, and you need personal responsibility, not this crutch of a medication”. The (kinda-strawman) left-wing version is something like “this is your inner creativity / spiritual conflict / capitalist brainwashing, and you need all-natural natureful weed, not this big pharma crap that’ll snuff out your inner light and make you a conformist sheep”. It would’ve saved me, and many of my friends, so much wasted time and life if there was a non-cringey non-boring cultural message/archetype/role-model/example of “actually, modern medicine works sometimes, so maybe try that first if you can afford it”.

    I may write a full post on this sometime, so that “Maybe Try Mainstream Medical Intervention” can enter the list of blog post titles memeplex of this community. (Seriously, where are the biographies of famous people that have a chapter on “he finally fixed his lifelong X by taking Y, and the problem didn’t come up again”? Surely famous people have been helped by “normal” mental-health medication before???). ↩︎

  3. While both are available in NYC and somewhat advertised, most of the focus has been on naloxone, which is very widely advertised, and available for free all over the city. This is good on its own, naloxone saves lives, but… let’s be honest, how often does it come on time? If you pass someone who looks asleep on the streets of New York, you don’t look closely for signs of overdose, or you would be stopping constantly. Some people use alone in their apartments or houses, and others who use in company are with other people also using, and so who aren’t the most competent to help them or even notice if help is needed. Test strips are a much more direct solution, which I suspect would at least help more than naloxone by preventing overdoses before they happen. But naloxone is just first aid once someone is high right? Test strips make you complicit because people will use them when they intend to shoot up. I am not certain that something like this is the motive behind the difference here, but it would be consistent with my other biggest problems with existing addiction treatment, and frankly mental healthcare in general. ↩︎

  4. I have discussed weed in the context of addiction, but so long as I’m talking about the general harmfulness of things like weed or shrooms, there is an important concession I should share. Outright “paradoxical” reactions to weed and shrooms seem to be even more common than to substances like alcohol and kratom that I ultimately think are worse overall. In the case of shrooms I think this is pretty well known in the form of “bad trips”, but I don’t know how many people understand this well in the context of weed. There is some popular understanding that you can sometimes get a “paranoia” reaction from weed. I think for many of the people I’ve spoken to who just dislike weed a bit this is a decent gloss of their reaction, but you can definitely get very very bad reactions from it as well. To reveal a bit of my casual media habits for a minute, this is the YouTuber Arin Hanson’s account for example. Something similar happened to me the one time I tried it.

    It’s hard to explain exactly, but my thoughts were all alternating, so that I couldn’t remember the thought one thought ago, but I could remember my thought two thoughts ago… and then when I had the next thought the same thing would happen, and I would forget the thought I just had, but remember the thought I had forgotten one thought before. If this is a headache to keep track of when reading about it, imagine it actually being what it is like in your brain for a minute. Inescapably. This forced me into this escalating panicked game of recursive mind telephone in real time, meanwhile time felt like it was passing much more slowly, trapping me in it for longer. The overall result was a feeling of mounting dread I could never properly trace or address but could only escalate with confusion. It was one of the most terrifying experiences of my life, I contemplated suicide at one point during it, and I begged my future self with everything I could to never ever try weed again if I managed to get out of this. I have so far held myself to that. I don’t find this toooo surprising, it’s a bit of a DARE talking point but also true that weed can contribute to triggering psychotic disorders in some people. ↩︎

  5. Ed. Note: Also kratom, like kava and weed, seems to have kind of a “natural, nice, authentic, traditional-medicine-type, natural, granola, countercultural” vibe, which I’d bet makes people subconsciously think it’s “nicer” than rave drugs or heroin or alcohol or… ↩︎

  6. Ed. Note: DnD, anyone? Or a rules-lite system like Fate? ↩︎

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