Are we addicts?

Good luck with that. Illicit drug use and addiction, and the illicit drug trade that fuels them, have huge social, personal, and health costs. About a quarter of a million deaths a year around the world are attributed to illicit drug use, and that doesn’t include the gang wars that go along with it. Add to that the enormous costs of policing, prosecution, incarceration, health care, social work, and so on, and the personal and societal costs of poor health, lower education and therefore lower employment, broken families, and on and on. I do not see a single point of overlap with diabetes, except perhaps the use of syringes.

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The analogy isn’t clear. I don’t know what glasses you are looking at it through.

No one is taking insulin to diminish consciousness or to produce hallucinations.

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No one does this on purpose. No one. It’s called a side effect not an addiction. Lots of other medications have side effects that are equally as unpleasant and/or lethal.

I also don’t see the value of the comparison at all. It’s not going to do anything to help advance a cure.

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Well, Beecher, if you consider the total cost of diabetes in terms of lost years of life, reduction in quality of life, expenses of medical care, increased disability from complications, and deaths from hypoglycemia, the lack of a cure for diabetes probably dwarfs the social costs of the recreational drug problem.

It is of course obvious that the analogy of diabetes to drug addiction is only approximate, as the very definition of ‘analogy’ implies, but still, the compulsion to take a drug, whether from medical need or addiction, plus its hallucinogenic, consciousness diminishing, and potentially lethal effects all support the comparison.

I think it’s a flimsy analogy because drug users or addicts take recreational drugs for the purpose of altering their consciousness. As others have said, no one takes insulin for this purpose. I think from reading your posts you struggle significantly with hypoglycemia and I’m sorry it’s like that for you. It’s really just a mere annoyance for me and way down the list of problems I have living with this disease. I’ve never lost consciousness or been close to death no matter how low I am, so I don’t think we will see eye to eye because it’s just not a big issue for me. I hate to say it, but sometimes (and I mean very rarely, but sometimes) it can be fun to drop a little low, have that voice in my head telling me “EAT, EAT, EAT” and binge on everything I have in my kitchen (and yes I know that’s a stupid idea that leads to blood sugars in the teens an hour later, but it’s just so much fun).

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As someone who studies substance use and abuse, I would say it’s a very bad analogy for many reasons. Now, it could be possible to use insulin in damaging ways, but using it as a diabetic is not the same as with a habit-forming substance, with which need for and dependency on the substance doesn’t initially exist but only develops and escalates as a direct result of continued use of the substance, both physiologically and with strong behavioral reinforcement. We use insulin because without it, we will die. That didn’t happen because we started using insulin; for T1s, it was because of an autoimmune disease. Most if not all of us would give up insulin in a second without a moment’s regret if we someday can while maintaining blood sugar control. That is not what addiction looks like. People suffering from addiction tend to feel very conflicted about the idea of giving up their substance of choice, even when they recognize that using it has risks and has caused harm. Even when they desperately want to stop, often another part really doesn’t want to or is distressed or saddened by the idea of losing that part of their life. Can’t think of too many diabetics who wouldn’t 100% celebrate if they could put down the insulin forevermore (at least assuming it didn’t require some bad side effect, like immunosuppressant drugs, to get us there).

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Many conventional addicts feel trapped by their dependency on the drugs they take, just as type 1 diabetics are trapped by our dependency on insulin. The constraint arises from different sources, but the strength of the compulsion is the same.

It is interesting that others have effectively recognized the similarity between type 1 diabetes and ordinary drug addiction as well. When I was an undergraduate and drug culture was at its peak, I was arrested twice during severe hypoglycemic episodes by the campus police, who both times asked me “What are you on,” assuming I was ‘high.’ I certainly looked as though I was impaired by some recreational drug, since I could not think, speak, walk, or stand properly, so I can see the grounds for their assumption.

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Nope. Actually my point was it’s not—addiction is much stronger since without physiological need, it persists.

This isn’t a similarity between diabetes and addiction. It’s a similarity between hypoglycemia and intoxication, which is an entirely different comparison of specific acute states, rather than broader pathological conditions. It’s sort of like how you previously conflated any alcohol use with alcohol abuse/addiction. These are very different concepts.

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Well, it’s a similarity between the symptom of treated diabetes known as diabetic hypoglycemia and the symptoms of addiction, so if you see it that way, the relationship is clearer.

I know that people don’t want to be associated with drug addicts because of their low social reputation, but many addicts, such as patients who have been treated with morphine for long periods in the hospital for pain control following a hip fracture, for example, have become addicted to drugs because of a medical condition, not by their own fault, so in this they are similar to diabetics.

Again, nope. Intoxication is a symptom of substance use, not necessarily substance abuse. A person can be intoxicated while not being addicted whatsoever. You keep making this error.

The intoxication and the addiction in diabetes both relate to the same drug, insulin, which, under the strict control regimens now insisted upon, will invariably produce occasional episodes of toxicity, such as loss of consciousness, and the addiction, used in the metaphorical sense here, is to that same drug, insulin, which must be taken to ensure survival. Again, I am suggesting this as an analogy, and analogies are, by definition, not equivalences, so in the setting of a general comparability highlighted by the comparison, not every single detail will match, nor need it to make the point. A hypoglycemic episode could be characterized as an episode of insulin toxicity consistently with how excess alcohol intake results in alcohol toxicity.

While I was growing up, and up until about the early 1970s, the term, ‘diabetic hypoglycemia,’ was not even used, and what are now called hypoglycemic periods were called ‘insulin reactions,’ highlighting the dependence of the event on the substance.

Yep, but there need to be enough similarities for 2 things to be analogous. You can’t just take 1 thing that’s sort of similar (extreme hypoglycemia and the effects of some drugs). Just admit it’s a bad analogy, if even an analogy at all, and move on.

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This isn’t addiction, though. Addicts don’t necessarily overdose on drugs, and people who overdose on drugs aren’t necessarily addicts.

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I think a better analogy is between me and a small aircraft given how much waste I generate each month (pump cannulas and tubing, insulin vials, etc. etc.). I’d ring up the EPA rather than the drug czar, but not sure the current administration cares too much about human environmental impact.

My daughter was a heroin addict for 12 years (she’s been sober now for 9 yrs). This “analogy” used to come up in some of the support group meetings we used to attend. And it’s utter nonsense.

The issues addicts struggle with are completely different. My daughter would be overwhelmed by cravings; she took heroin because of its psychotropic effects, not in spite of them, etc. etc. We don’t crave insulin and we don’t take it for the psychotropic effects: horrible as they are, we do our damnedest to avoid them. The only reason this analogy popped into people’s heads was because of the superficial and meaningless coincidence that both are associated with syringes.

An analogy can be helpful if it reveals an essential commonality in things that are superficially different. It’s not helpful if it confuses things that are essentially different, even if they have some superficial similarities. The kinds of problems my daughter faced and faces due to her substance abuse are particular to that disease and have nothing to do with the reasons why I have to take insulin and the difficulties I face because of it. Confusing the two is a disservice to her disease as well as mine. Please stop.

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Well, the analogy between drug addiction and diabetes with hypoglycemia was so profoundly clear to two policemen who, on different occasions, arrested me as a drug addict when I was stumbling around outside with a low, that they would not let me go no matter how much I tried to explain things to them, after having stuffed some candy into my mouth.

Diabetes, like an addiction to recreational drugs, compels people to take a drug they eventually don’t want to take, and the drug can cause diminished consciousness, hallucinations, and death. Like morphine, insulin can be taken in appropriate doses where it has a medical benefit, and in excess where it causes diminished consciousness, hallucinations, and possibly death. So in some respects it’s analogous, in others not, as in all analogies.

If you call someone a pig, he can’t reasonably defend himself by pointing out that he doesn’t have a curly tail, doesn’t say ‘oink,’ and is not suitable for making good hot dogs. You would say to him, “You’re missing the point of my analogy.”

It was “profoundly clear” to them, but they were confusing two fundamentally different things because of a superficial similarity. The ultimate point of your story is that they were wrong.

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