(Now , this is coming from someone who some folks think has a serious personaility disorder, so take it or leave it for what its worth!)

Back in the late 70s I worked graveyard shift as an orderly in an ER in Boston. We saw lots of "unusual" folks. One of the customers I remember most vividly was a gent who came in with a 2-3" gash on his head from a bar room encounter. Funny, we thought, he seems a little tipsy, but he's trying to be charming -- wants to talk about the Red Sox. 20 minutes later we find him rummaging through a supply drawer stuffing syringes in his pockets. We fix that and put a security guard on him. But he still wants to chat us up about the Red Sox. Well, we're less inclined to talk sports at this point, so he gets mad and abusive -- won't stay in the treatment room, won't lie down, takes a swing at one of us -- but still wants to chat about the Red Sox. After about 2 hours of this little behavioral roller-coaster, we document his refusal to accept treatment and we kick him out. He hails a cab and disappears.

We discover later that this scene was repeated in at least 7 other ERs that night. Not sure he ever got stitched up -- after a certain amount of time has passed nobody will suture a wound like that, and he'd have one ugly scar today as a result.

Anyhow, in our clean utility room we had a few signs, humorous and otherwise. One of them was "YOU CAN'T ARGUE WITH A DRUNK". In my three years there I came to a progressively stronger conclusion that there really wasn't much of a percentage in chatting about the Red Sox with inebriated customers -- that more often than not the discussion went places that weren't worthwhile or that were downright aggravating.

OK, so I'm no model for perfect social behavior, but, as I see a fellow citizen (cringe!) throw out absolutely ignorant, mean-spirited comments on this BBS, completely earning the title of "dink", I am reminded of that sign. You can't argue with a drunk. And I don't think I'll be chatting about sports (or Empegs) with that drunk, either.

How many other BBSes will my drunken fellow citizen visit tonight?

(BTW.... NWMT: I like it!)

Amen.

Well said... The problem is that those who have not yet gone through such an experience and learned not to respond to said drunk are going to get into similar episodes, which will continue to clutter things and lead to some unhappy citizens. It's almost like you have to put a giant warning sign on the New Post page to let people know who the idiots are. Or just killfile them.. DAMN this BBS needs a killfile.

My sister and brother-in-law are both ER paramedics.. They often try to make it SO boring that the drunks leave... Cuz drunks just LOVE a fight.

They often try to make it SO boring...

We tried, but it can be tough. We had this woman in black leather come in one time with a bump on her head, she said her name was Jennifer Coriolis, but she kind of looked like Jennifer....um......Garner...................Jennifer........ Gaaaaarner..........Jennifer Gaaaaarrrrrrrrner!.................................

Uh, where was I?

Bump. OK, a shameless bump. So disparage me!

This morning, I was thinking about what prompted me to write this somewhat wordy post a while back. Well, it is ever more clear. There are folks in the world who really don't care what kind of reaction they get so long as they get *some* kind of reaction. Not-yet-mature folks who seek attention. Praise them, kiss them or dump a bucket of manure over their head, it's all the same. Attention.

The only sensible way I've found to deal with that in a BBS context is a kill file. In the absence of a kill file facility I use a "virtual kill file" (or is that a "virtual kill file emulator"?). If "X" is in the kill file, when I see a post by X, I a) don't read it and b) put the thread in threaded mode and don't read any posts that are descendants of X's post.

This doesn't work perfectly but it works. Also, I suppose it's not for everybody. It's a little "dark" - implies that salvation may *not* be possible for all -- runs against that very human hope that the Xs of the world will some around and adopt more reasonable social behavior. Well, sometimes they do and sometimes they don't. It's not my decision. At some point, though, we found that we had to kick one or two out of the ER so that the ER could continue to serve its intended function.

Yes. We call them "goths" here in the states.

I work in a hospital, and that kind of event occurs all too often. People will do anything to get their hands on drugs. Addiction is pretty horrible. When I was taking psych courses, I had to go and watch a few AA/NA meetings. It was pretty sad. I don't want to say specific things, but it's pretty common for drug addicts to mutilate themselves in order to get pain killers and other narcotics. They pull their own teeth out, cut themselves to get into an ER.. I don't know, maybe i've never had good enough stuff to flip me out like that, or i'm too much of a pussy. But that's just me. I still feel bad for them..

However, I think being attention-starved and addicted to drugs are two seperate things. But they probably both spawn from daddy ignoring [youknowwho] when he was a kid.

All in all, I know what you mean. a troll is a troll is a troll. heh.

Well said, Jim. I've come to learn, in this world, that there are some people who just either just don't get it, have comletely twisted logic that will hurt themselves, or think so differently and don't want to hear otherwise.

I have learned to dismiss these people. It's hard when you really want to set things straight or at least clarify your point of view to the point where the person understands and can accept it as mine. It's frustrating to not respond. But I've found it keeps me a little more sane. It also keeps from propogating trolls and other people who try to get a reaction out of you just to get one.

I think I'm a lot calmer these days and more relaxed as a result

I work in a hospital, and that kind of event occurs all too often. People will do anything to get their hands on drugs. Addiction is pretty horrible. When I was taking psych courses, I had to go and watch a few AA/NA meetings. It was pretty sad. I don't want to say specific things, but it's pretty common for drug addicts to mutilate themselves in order to get pain killers and other narcotics. They pull their own teeth out, cut themselves to get into an ER.. I don't know, maybe i've never had good enough stuff to flip me out like that, or i'm too much of a pussy. But that's just me. I still feel bad for them..

Looking back on it, I don't think that guy's main problem was addiction (he was stuffing not just syringes in his pockets, but instruments and everything else!), but who knows? We *did* have a steady stream of folks -- generally referred to as "turkeys" - who came in with dental work that they left purposefully unrepaired (so they could say "my dentist is away at a conference, this filling fell out, and it's killing me!"), or feigned kidney stones or chest pain so that they could get a blast of morphine, demerol, dilaudid, percodan, whatever. We had an informal phone network between ERs that we used to track whether somebody had already been seen and turkified earlier that night somewhere else. The accomplished chest painers usually got the morphine until their chart was dug up and then -- bang -- Narcan (narcotic antagonist). Party's over. If anybody's ever been fortunate to have a good blast of morphine preoperatively for elective surgery (meaning you weren't in pain to start with) then you've probably gotten a hint of how good serious narcotics are. The question is then whether you devote the rest of your life to seeking them out.

However, I think being attention-starved and addicted to drugs are two seperate things. But they probably both spawn from daddy ignoring [youknowwho] when he was a kid.

I should be careful of trying to stretch my analogy/parable too far or of concocting some diagnosis from afar. I'm no psychiatrist (and good, solid diagnoses elude *them* more than half the time!). All I know is that it pains me to watch the good, helpful nurses, doctors, ward clerks and orderlies of the Benevolent Empeg ER argue with a drunk.

All in all, I know what you mean. a troll is a troll is a troll. heh.

Yep.

If anybody's ever been fortunate to have a good blast of morphine preoperatively for elective surgery (meaning you weren't in pain to start with) then you've probably gotten a hint of how good serious narcotics are. The question is then whether you devote the rest of your life to seeking them out.

I know this belongs in our separate "depression and addiction" discussion thread, but I just wanted to say that there is mounting evidence to suggest that this is largely determined by genetics. In other words, some people can take certain drugs without easily getting addicted, others will become hopelessly hooked with one snort.

I know this belongs in our separate "depression and addiction" discussion thread....

Yes...I'd post something there, but, sadly, most of that thread went somewhere that I wasn't willing to follow....

, but I just wanted to say that there is mounting evidence to suggest that this is largely determined by genetics. In other words, some people can take certain drugs without easily getting addicted, others will become hopelessly hooked with one snort.

I agree in the main. When I said "The question is then whether you devote the rest of your life to seeking them out." I hope I didn't imply too much about causation -- exactly why some people do/don't spend the rest of their lives...

With respect to "hopelessly hooked with one snort", though, I'm not sure whether there are examples of that in the addiction literature. Yes, people do start with one snort (of whatever), keep going, and can become addicted quickly. As with many things, I think there are a mix of factors at work and individuals don't necessarily fall into Type A or Type B. Some folks spend a lot of time actively using drugs but then manage to stop forever, while others may go for the first 40 years of their life without serious drug use then experience a serious course change and be lost to drugs until they die.

Me? I've probably had more narcotics than the average citizen (by prescription) and have administered about 500 times more than I have taken in. If there wasn't a down side (like losing employment, addiction, having to shoot up, heart valve infections, social ostracism, jail time), I suppose it would be great to get a blast of morphine once or twice a year (say on vacation, on a beach in the Caribbean), but things don't work that way. I'm one of those long-term moderately depressed folks that other posts have talked about and it could be easy to fall down the hole.

BTW, I think Bitt's post that started the depression thread/s is pretty much dead on, FWIW.

With respect to "hopelessly hooked with one snort", though, I'm not sure whether there are examples of that in the addiction literature.

Well, I knew one coke addict who specifically told me that was exactly the case for her. I don't know if she was exaggerating or not. I don't have any medical references to back up the statement, though, so I will defer to the CW on that subject. My point was that there are some people who have tendencies towards either end of the spectrum, and from what I've heard, those tendencies are often genetically determined.

It also depends on the substance. I have very little experience in the matter, but I have never heard of anyone "trying" herione or crack without addiction soon following.

<public apology>

I'm sorry about trashing that other thread with my Gas Mark 8 flame. It certainly wasn't my intention to hijack the thread into obliivion, although my post certainly sent it there.

About a year ago I lost a friend to a deadly concoction of alcohol and anti-depressants. He had suffered with both alcoholism and depression for many years, and finally had had enough of it. He wasn't a particulary close friend - I hadn't spoken to him in about 5 years, but he had one of the most gentle souls I've ever met. He'd go out of his way to try and bring a smile to *anybody's* day. But even when life was going really well for him, he still couldn't find any lasting happiness outside of a bottle of booze. Even when laughihng and joking outwardly, inside he was constantly battling a dark cloud.

For some people, life just sucks.

I'm sorry guys. I'll try not to let my emotions get the better of me again.

</public apology>

Tony: Well, I knew one coke addict who specifically told me that was exactly the case for her. I don't know if she was exaggerating or not. I don't have any medical references to back up the statement, though, so I will defer to the CW on that subject. My point was that there are some people who have tendencies towards either end of the spectrum, and from what I've heard, those tendencies are often genetically determined.

I used to pay more attention to the biological literature and politics of addiction than I have recently, so I stand ready to be corrected and informed by someone with more information. I don't really disagree re: genetic determination, although I probably think of it more in terms of predisposition -- stroner or weaker -- that interracts with other factors.

Paul: It also depends on the substance. I have very little experience in the matter, but I have never heard of anyone "trying" herione or crack without addiction soon following.

Some drugs, I think, are generally acknowledged to have much greater addictive characteristics than others, heroin and crack ranking right up there. I can tell you, though, that there are people who have tried one or both of those and who did not become addicted (I've met a few of them).

It is hard to control for "genetic predisposition" when what constitutes that is so poorly understood, but allow me to offer this (admittedly artificial, ginned-up) example:

Two 21 year-old women, each with "comparable" genetic predisposition to crack cocaine addiction are each given an identical dose of crack -- their first -- on a single Saturday evening. "Sue" is one of two children from a middle class suburb of Gotham, has never taken drugs before, has a steady boyfriend, and is scheduled to attend her college graduation on Sunday; the dose is administered by her "wild" college roomate. "Jane" is one of 8 children of a drug-addicted mother raised in foster homes, has two children of her own, is essentially unemployed, but is now becoming acquainted with the neighborhood pimp, who administers the dose.

I can't predict who will become addicted, but, of these two women, I have to guess that one is more likely to become addicted than the other.

So, my view of biological determinants in addiction is a mixed one. I accept the concepts of genetic predispositions in general, but I am a little wary of the tendency to "medicalize" everything to the exclusion of multi-factor causation. Also, with respect to addicts' attitudes toward addiction and statements like being addicted at the first whiff, it is my sense that there is a whole secondary culture of addiction that revolves around prevalent addiction theory and treatment (lately more medicalized) that influences the world view of recovering addicts. There are times I could almost believe that treatment and recovery are substitute addictions.

Sue and Jane are hypothetical construtcts in your example. And as you said, the genetic factors are hard to put into a controlled test since they are still only marginally understood. So which one of these two women becomes addicted is going to have to remain a theory for now.

Even when laughihng and joking outwardly, inside he was constantly battling a dark cloud.

Yup. I worked on a psych unit in Boston for a year. One patient was a handsome, athletic, charming, bright, guy in his mid 20s. He had 3-4 well-adjusted siblings and parents who seemed very nice. He also had multiple admissions for suicide attempts. All the female staff were in love with this guy -- a "hunk" in their words. None of that mattered. The list of things he enjoyed got shorter and shorter until the only thing left was downhill skiing. Late that summer he parked his dad's car on the top of the Tobin bridge and walked off the edge.

So, as much as I quibble about multifactorial causes and such, I do not want to minimize the biological.

Sue and Jane are hypothetical construtcts in your example. And as you said, the genetic factors are hard to put into a controlled test since they are still only marginally understood. So which one of these two women becomes addicted is going to have to remain a theory for now.

As I said, ginned-up. All that aside, the obvious point of the example is to promote my theory that Jane is more likely to become addicted.

I don't feel bad about not being able to predict any of this more definitely or to offer a better example. I think that this is still the kind of stuff that addiction "experts" argue about all the time.

All that aside, the obvious point of the example is to promote my theory that Jane is more likely to become addicted.

And until we can find a pair of genetically identical twins, separated at birth, one living in upper-middle-class and the other living in a ghetto, who are willing to participate in this experiment, it will remain a theory.

I see your point that addiction has environmental factors as well as genetic ones. I'm just seeing it from a different perspective: Even in a drug-abuse-friendly local culture, some people will be more genetically predisposed to become addicted than others. It's just in that culture, they're more likely to get more doses of the drug, which will trigger addiction even in those not predisposed to it.

And until we can find a pair of genetically identical twins, separated at birth, one living in upper-middle-class and the other living in a ghetto, who are willing to participate in this experiment, it will remain a theory.

Dang, how many times do I have to apologetically qualify this example with adjectives like "artificial"?

With respect to some people will be more genetically predisposed to become addicted than others. It's just in that culture, they're more likely to get more doses of the drug, which will trigger addiction even in those not predisposed to it. I *think* we are strongly agreeing. I just can't tell.

My example and theory uses contrived single-person examples where no truly exact comparison is possible.

Let's slice it another way - a more legitimate population-based approach: Let's conduct a highly statistically significant study of crack addiction among women aged 17-25 in all affluent suburbs in the U.S. and in all inner-city neighborhoods that meet certain poverty criteria. We'll stratify the results by suburb vs. inner-city. If we observe a significant difference, and I'm guessing we will, we'll then call the biologists and geneticists and leave it to them to explain it!

Again, I think that this is the kind of stuff that addiction "experts" still argue about all the time. I'm guessing that plenty of academic experts have done pop-based studies like that, probably go to a lot of trouble to control for factors like race, age at first exposure, nativity, family size, etc. but have a challenging time with the analysis. If I wasn't so lazy, I'd go do a literature review.

Some drugs, I think, are generally acknowledged to have much greater addictive characteristics than others, heroin and crack ranking right up there.

Possibly the most addictive being nicotine.

A friend of mine used to be a serious cocaine addict. Serious is his word: he said he was using about twice as much cocaine as a typical addict, this in Southern Florida where there is a lot if it floating around. One morning he woke up more dead than alive, no idea where he was, how he got there or what he had done the night before, and decided "This stuff is gonna kill me. I quit." And he quit cold turkey -- never touched the stuff again.

A few years later he met the woman he decided on the spot that he wanted to marry. Asked her out on a date. She told him that "...I don't think I could date somebody who smoked." He took his cigarettes, crumpled them up and pitched them in the trash, said "OK. I just quit." He never touched tobacco again -- and married the woman, too.

The interesting thing is, when he told me this story, he said, "Kicking the cocaine was easy compared to giving up tobacco. I am still addicted to nicotine -- I just don't use it any more."

tanstaafl.

And until we can find a pair of genetically identical twins, separated at birth, one living in upper-middle-class and the other living in a ghetto

Tony, another thought: I'm not sure that it satisfies all of your conditions, but I was reminded of the many famous "twin studies" that were conducted in the study of schizophrenia and, sure enough, there are a series of twin studies such as this one sponsored by NIDA. From what I can tell from reading the abstracts, the studies confirm the genetic component of addiction (we knew that, right?) and, to some extent, include environmental factors. So, perhaps the prospect of a Sue-and-Jane analysis aren't so far-fetched.

With almost any research, I like to give it a while to "level out". As with studies of hormone therapy, it often seems that various studies can see-saw in contradictory fashion until they reach some sort of equilibrium!

He never touched tobacco again -- and married the woman, too.

Rock on. You go guy!

The interesting thing is, when he told me this story, he said, "Kicking the cocaine was easy compared to giving up tobacco. I am still addicted to nicotine -- I just don't use it any more."

I don't want to strike some "It was Hell!" pose, but, having spent some time babysitting folks withdrawing from heroin on detox units, I can report that the month I spent withdrawing from a 14-year ciggie addiction in 1979 was *much* worse than the 3-4 day "flu" I saw most of them go through. After the first 3-4 days, a lot of it *did* seem psychological -- like "what the hell do I do with my hands after dinner if they aren't holding a cigarette?" -- but things didn't get much easier for a full month and I had full-blown smoking nightmares (yes, wake up bolt-upright with heart rate=200 Havor Nocturnus) for 6 months.

I am currently engaged in keeping my best friend snuff-free so that he may live to see his grandchildren and I can say that he is not having any easy time of it. It ain't easy.

Anyhow, these "war stories" aside, recent research seems to back up what your friend said with respect to addiction power of tobacco. Bad stuff.

Except that you can get addicted to crack after only smoking one or two times. I think cocaine takes about 6 months on average.

How long does it take to get addicted to tobacco? A year? Maybe less? Anyone?

Yz33d, any reason for an avatar that tries to set a cookie from Microsoft.com?

It's where he's stealing the picture from this month.

http://research.microsoft.com/~conal/Pan/Gallery/PanPics/spiral_dots_small.jpg

If you're going to *steal* other people's graphics, at least copy it to another server instead of referencing it off of this poor sod's web page.

I know people who have gotten addicted to cocaine after thei first line. No one has mention the most addictive substance on the face of the earth. McDonalds Chicken McNuggets. Ive been addicted for the last 3 monthes, I can not stop eating them the people at McDonalds know me by name. I swear they put nicotine in them.

How do you do that?