Editor's Choice

Treat addictions with evidence, not ideology

BMJ 2017; 357 doi: https://doi.org/10.1136/bmj.j1925 (Published 20 April 2017) Cite this as: BMJ 2017;357:j1925

Addiction: Imaginary Gains & Real Losses

Addiction is a bad bargain with imaginary gains (euphoria) and real losses (sickness). Euphoria is a false, fleeting sense of well-being that makes addicts feel “high” and masks the sustained sickness of addiction. Even worse, the euphoria and sickness of addiction are polar opposites that reinforce each other and trap addicts in a vicious cycle of Jekyll & Hyde mood swings that are unique for each addiction. For example:

1. Sugar creates the euphoria of feeling sweet, but the sickness of being bitter.
2. Chocolate creates the euphoria of feeling love, but the sickness of being love-starved.
3. Vanilla creates the euphoria of feeling happy, but the sickness of being sad.
4. Cola creates the euphoria of feeling hydrated, but the sickness of being dehydrated.
5. Caffeine creates the euphoria of feeling energetic, but the sickness of being lethargic.
6. Alcohol creates the euphoria of feeling relaxed, but the sickness of being uptight.
7. Tobacco creates the euphoria of feeling aerated, but the sickness of being suffocated.
8. Analgesics create the euphoria of feeling pain-free, but the sickness of being pain sensitive.
9. Hallucinogens create the euphoria of feeling wise, but the sickness of being confused.
10. Gambling creates the euphoria of feeling lucky, but the sickness of being unlucky.

Addiction is a deadly paradox. The more you know it, the more it fools you; the more you use it, the more it controls you; and the more you enjoy it, the more it hurts you. In short, addiction is hell you enjoy. To quote Virgil's Aeneid, "The descent to hell is easy."

Competing interests: No competing interests

20 April 2017
Hugh Mann
Physician
Retired
New York, NY, USA
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