Which Addiction-Quitting Methods Work Best?

In Tuesday’s newsletter we asked you what, in your opinion, is the best way to cure an addiction. We got the above-depicted, below-described, interesting distribution of responses:

• About 29% said: “Addiction cannot be cured; once an addict, always an addict”
• About 26% said “Cold turkey (stop 100% and don’t look back)”
• About 17% said “Gradually reduce usage over an extended period of time”
• About 11% said “A healthier, but somewhat like-for-like, substitution”
• About 9% said “Therapy (whether mainstream, like CBT, or alternative, like hypnosis)”
• About 6% said “Peer support programs and/or community efforts (e.g. church etc)”
• About 3% said “Another method (mention it in the comment field)” and then did not mention it in the comment field

So what does the science say?

Addiction cannot be cured; once an addict, always an addict: True or False?

False, which some of the people who voted for it seemed to know, as some went on to add in the comment field what they thought was the best way to overcome the addiction.

The widespread belief that “once an addict, always an addict” is a “popular truism” in the same sense as “once a cheater, always a cheater”. It’s an observation of behavioral probability phrased as a strong generalization, but it’s not actually any kind of special unbreakable law of the universe.

And, certainly the notion that one cannot be cured keeps membership in many 12-step programs and similar going—because if you’re never cured, then you need to stick around.

However…

❝What is the definition of addiction?

Addiction is a treatable, chronic medical disease involving complex interactions among brain circuits, genetics, the environment, and an individual’s life experiences. People with addiction use substances or engage in behaviors that become compulsive and often continue despite harmful consequences.

Prevention efforts and treatment approaches for addiction are generally as successful as those for other chronic diseases.❞

~ American Society of Addiction Medicine

Or if we want peer-reviewed source science, rather than appeal to mere authority as above, then:

❝What is drug addiction?

Addiction is defined as a chronic, relapsing disorder characterized by compulsive drug seeking and use despite adverse consequences. It is considered a brain disorder, because it involves functional changes to brain circuits involved in reward, stress, and self-control. Those changes may last a long time after a person has stopped taking drugs.

Addiction is a lot like other diseases, such as heart disease. Both disrupt the normal, healthy functioning of an organ in the body, both have serious harmful effects, and both are, in many cases, preventable and treatable.❞

~ Nora D. Volkow (Director, National Institute of Drug Abuse)

Read more: Drugs, Brains, and Behavior: The Science of Addiction

In short: part of the definition of addiction is the continued use; if the effects of the substance are no longer active in your physiology, and you are no longer using, then you are not addicted.

Just because you would probably become addicted again if you used again does not make you addicted when neither the substance nor its after-effects are remaining in your body. Otherwise, we could define all people as addicted to all things based on “well if they use in the future they will probably become addicted”.

This means: the effects of addiction can and often will last for long after cessation of use, but ultimately, addiction can be treated and cured.

(yes, you should still abstain from the thing to which you were formerly addicted though, or you indeed most probably will become addicted again)

Cold turkey is best: True or False?

True if and only if certain conditions are met, and then only for certain addictions. For all other situations… False.

To decide whether cold turkey is a safe approach (before even considering “effective”), the first thing to check is how dangerous the withdrawal symptoms are. In some cases (e.g. alcohol, cocaine, heroin, and others), the withdrawal symptoms can kill.

That doesn’t mean they will kill, so knowing (or being!) someone who quit this way does not refute this science by counterexample. The mortality rates that we saw while researching varied from 8% to 37%, so most people did not die, but do you really want (yourself or a loved one) to play those odds unnecessarily?

See also: Detoxification and Substance Abuse Treatment

Even in those cases where it is considered completely safe for most people to quit cold turkey, such as smoking, it is only effective when the quitter has appropriate reliable medical support, e.g.

• Without support: 3–5% success rate
  • The study: Shape of the relapse curve and long-term abstinence among untreated smokers
• With support: 22% success rate
  • The study: Gradual Versus Abrupt Smoking Cessation: A Randomized, Controlled Noninferiority Trial

And yes, that 22% was for the “abrupt cessation” group; the “gradual cessation” group had a success rate of 15.5%. On which note…

Gradual reduction is the best approach: True or False?

False based on the above data, in the case of addictions where abrupt cessation is safe. True in other cases where abrupt cessation is not safe.

Because if you quit abruptly and then die from the withdrawal symptoms, then well, technically you did stay off the substance for the rest of your life, but we can’t really claim that as a success!

A healthier, but somewhat like-for-like substitution is best: True or False?

True where such is possible!

This is why, for example, medical institutions recommend the use of buprenorphine (e.g. Naloxone) in the case of opioid addiction. It’s a partial opioid receptor agonist, meaning it does some of the job of opioids, while being less dangerous:

SAMSHA.gov | Buprenorphine

It’s also why vaping—despite itself being a health hazard—is recommended as a method of quitting smoking:

Vaping: A Lot Of Hot Air?

Similarly, “zero alcohol drinks that seem like alcohol” are a popular way to stop drinking alcohol, alongside other methods:

How To Reduce Or Quit Alcohol

This is also why it’s recommended that if you have multiple addictions, to quit one thing at a time, unless for example multiple doctors are telling you otherwise for some specific-to-your-situation reason.

Take care!

What’s The Deal With MSG?

There are a lot of popular beliefs about MSG. Is there a grain of truth, or should we take them with a grain of salt? We’ll leap straight into myth-busting:

MSG is high in salt

True (technically) False (practically)

• MSG is a salt (a monosodium salt of L-glutamic acid), but to call it “full of salt” in practical terms is like calling coffee “full of fruit”. (Coffee beans are botanically fruit)
• It does contain sodium, though which is what the S stands for!
• We talked previously about how MSG’s sodium content is much lower than that of (table) salt. Specifically, it’s about one third of that of sodium chloride (e.g. table salt).

MSG triggers gluten sensitivity

False!

Or at least, because this kind of absolute negative is hard to prove in science, what we can say categorically is: it does not contain gluten. We understand that the similar name can cause that confusion. However:

• Gluten is a protein, found in wheat (and thus wheat-based foods).
• Glutamate is an amino acid, found in protein-rich foods.
• If you’re thinking “but proteins are made from amino acids”, yes, they are, but the foundational amino acid of gluten is glutamine, not glutamate. Different bricks → different house!

The body can’t process MSG correctly

False!

The body has glutamate receptors throughout the gut and nervous system.

The body metabolizes glutamate from MSG just the same as from any other food that contains it naturally.

Read: Update on food safety of monosodium l-glutamate (MSG) ← evidence-based safety review

MSG causes “Chinese Restaurant Syndrome”

False!

Racism causes that. It finds its origins in what was originally intended as a satirical joke, that the papers picked up and ran with, giving it that name in the 1960s. As to why it grew and persisted, that has more to do with US politics (the US has been often at odds with China for a long time) and xenophobia (people distrust immigrants, such as those who opened restaurants), including nationalistic rhetoric associating immigrants with diseases.

Read: Xenophobia in America in the Age of Coronavirus and Beyond ← academic paper that gives quite a compact yet comprehensive overview

Research science, meanwhile, has not found any such correlation, in more than 40 years of looking.

PS: we realize this item in the list is very US-centric. Apologies to our non-US subscribers. We know that this belief isn’t so much of a thing outside the US—though it certainly can crop up elsewhere sometimes, too.

Are there any health risks associated with MSG, then?

Well, as noted, it does contain sodium, albeit much less than table salt. So… do go easy on it, all the same.

Aside from that, the LD50 (a way of measuring toxicity) of MSG is 15.8g/kg, so if for example you weigh 150lb (68 kg), don’t eat 2.2lb (a kilogram) of MSG.

There have been some studies on rats (or in one case, fruit flies) that found high doses of MSG could cause heart problems and/or promote obesity. However:

• this has not been observed to be the case in humans
• those doses were really high, ranging from 1g/kg to 8g/kg. So that’d be the equivalent of our 150lb person eating it by the cupful
• it was injected (as a solution) into the rats, not ingested by them
• so don’t let someone inject you with a cup of MSG!

Read: A review of the alleged health hazards of monosodium glutamate

Bottom line on MSG and health:

Enjoy in moderation, but enjoy if you wish! MSG is just the salt form of the amino acid glutamate, which is found naturally in many foods, including shrimp, seaweed, and tomatoes.

Scientists have spent more than 40 years trying to find health risks for MSG, and will probably keep trying (which is as science should be), but for now… Everything has either come up negative, or has been the result of injecting laboratory animals with megadoses.

If you’d like to try it in your cooking as a low-sodium way to bring out the flavor of your dishes, you can order it online. Cheapest in bulk, but try it and see if you like it first!

(I’ll be real with you… I have 5 kg in the pantry myself and use about half a teaspoon a day, cooking for two)