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Author’s Note: This post is part of a larger sequence on addiction, and sampled from an appendix post of mine. For more background on the appendix format I used, read this.
If you are in, suspect you are in, or have struggled in the past with some sort of addiction, feel free to join this Discord server. It is a recovery group I set up focused on helping EAs struggling, in case they think they would benefit from having a space where they can discuss more unique struggles with a group of people who are more likely to understand them. It is currently relatively inactive, but I am trying to change this. If you are uncomfortable with this for any reason, but still want help, feel free to get in touch via DMs, and I can try to help you in some other way.
Image from the painting “The Poet Max Herrmann-Neisse” by George Grosz
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[1]. 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.
ed. note: DnD, anyone? Or a rules-lite system like Fate? ↩︎
