Scott Alexander examines the surprisingly broad effects of GLP-1 drugs like Ozempic, exploring their mechanisms and speculating on why they seem to impact so many different conditions. Longer summary

Scott Alexander explores the wide-ranging effects of GLP-1 receptor agonist medications like Ozempic, which are approved for diabetes and obesity but show promise for many other conditions. He delves into the mechanisms behind their effects on diabetes, weight loss, and addiction, speculating on why these drugs seem to have such broad impacts. The post discusses how GLP-1 drugs work in the brain to reduce hunger and dampen reward systems, potentially explaining their effects on addiction. Scott also touches on their anti-inflammatory properties and potential benefits for neurodegenerative diseases, while cautioning that some reported effects may not replicate. Shorter summary

Scott Alexander addresses comments on his fetish and AI post, defending his comparison of gender debates to addiction and discussing various theories on fetish formation and their implications for AI. Longer summary

Scott Alexander responds to comments on his post about fetishes and AI, addressing criticisms of his introductory paragraph comparing gender debates to opioid addiction, discussing alternative theories of fetish formation, and highlighting interesting comments on personal fetish experiences and implications for AI development. He defends his stance on the addictive nature of gender debates, argues for the use of puberty blockers, and explores various theories on fetish development and their potential relevance to AI alignment and development. Shorter summary

Scott Alexander examines the Buddhist concept of jhana, a blissful meditative state, through Nick Cammarata's experiences, exploring its implications for understanding pleasure and reinforcement. Longer summary

Scott Alexander discusses the concept of jhana, a state of extreme bliss achieved through meditation in Buddhism. He focuses on Nick Cammarata's experiences with jhana, describing it as incredibly pleasurable yet non-addictive. The post explores the paradox of jhana being more pleasurable than sex but less reinforcing, challenging conventional models of reward and pleasure. Scott also mentions the Qualia Research Institute's approach to understanding these phenomena and poses discussion questions about the nature of pleasure, reinforcement, and decision-making in relation to jhana. Shorter summary

Scott proposes the concept of 'microaddictions', comparing eating habits and other enjoyable activities to drug addiction patterns, challenging traditional views on addiction. Longer summary

Scott explores the concept of 'microaddictions' by comparing the experience of eating tasty food, particularly potato chips, to drug addiction. He notes similarities in patterns of habituation, tolerance, and withdrawal, even within a short timespan like a single meal. The post extends this analogy to other enjoyable activities like watching movies, questioning whether 'flow states' are a form of microaddiction. Scott challenges purely chemical definitions of addiction, suggesting instead that addiction occurs when one aspect of our normal motivation system becomes disproportionately strong, whether through chemical or non-chemical means. Shorter summary

A review of 'Addiction By Design' examines how gambling machines are engineered for addiction and draws parallels to other digital technologies. Longer summary

This review of 'Addiction By Design' by Natasha Dow Schüll explores how gambling machines are designed to be addictive, and how this relates to other forms of digital addiction. The review covers the evolution of slot machines from mechanical to digital, various design techniques used to maximize addictiveness, and the psychology of machine gamblers seeking escape into a 'zone' state. It challenges the idea that gambling addiction is purely a personal failing, arguing instead that it results from an interaction between individuals and carefully engineered machines. The review also draws parallels to other potentially addictive technologies like social media apps. Shorter summary

Scott Alexander critiques Bryan Caplan's constraints vs preferences model of mental illness, proposing instead a goals vs urges framework that better explains both mental and physical health issues. Longer summary

Scott Alexander responds to Bryan Caplan's critique of psychiatry, focusing on Caplan's distinction between constraints and preferences in mental illness. Scott argues that this model is flawed and doesn't accurately represent mental or even many physical illnesses. He proposes a more nuanced model based on goals (endorsed preferences) and urges (unendorsed preferences), using examples to show how this better explains behavior in both mental and physical health contexts. Scott concludes that this model allows for a more libertarian approach, supporting individuals in achieving their goals, whether through addressing constraints or managing urges. Shorter summary

Scott Alexander argues that pseudoaddiction is a real and important concept, despite being widely denounced as pharma propaganda in the context of the opioid crisis. Longer summary

Scott Alexander argues that pseudoaddiction - the concept that some drug-seeking behaviors are due to undertreated pain rather than addiction - is real and important, despite being widely denounced as pharma propaganda. He presents several case studies from his own practice where patients exhibited 'drug-seeking behavior' for legitimate medical reasons. Scott criticizes a key paper arguing against pseudoaddiction, suggesting its arguments are muddled and flawed. He theorizes that while the concept started well-intentioned, it was co-opted by pharma companies, leading to media exaggeration and expert silence. Scott concludes that the denial of pseudoaddiction represents a failure of epistemics amid moral panic about the opioid crisis. Shorter summary

Scott Alexander discusses new research suggesting ketamine's antidepressant effects may be linked to the opioid system, exploring the implications and potential future directions for depression treatment. Longer summary

Scott Alexander provides an update on ketamine research, discussing a new study that suggests ketamine's antidepressant effects may be related to the opioid system rather than NMDA receptors as previously thought. He compares this to a study on buprenorphine's effects on suicidal ideation and explores the implications of these findings. The post touches on the medical establishment's response, potential future directions for research and treatment, and the historical context of opiate use in medicine. Scott also raises questions about the relationship between opiates and depression, and the potential risks and benefits of using opioid-related treatments for depression. Shorter summary

Scott Alexander challenges the popular interpretation of the Rat Park study, arguing that addiction is not solely caused by poor environments and emphasizing genetic factors in addiction susceptibility. Longer summary

Scott Alexander critiques the 'Rat Park' study and its popularized interpretation that drug addiction is primarily caused by poor social environments. He presents historical examples of addiction in seemingly happy or fortunate individuals, such as Ogedei Khan and Native Americans, to challenge this view. The post then discusses the genetic factors in addiction, citing twin studies and known genetic markers. Scott acknowledges that unhappiness likely contributes to drug use but argues that the relationship between environment and addiction is more complex than the Rat Park model suggests. He proposes a toy model where other sources of reward can help resist drug addiction, but maintains that biological interventions like deregulating suboxone and researching psychedelic therapy are more immediately effective for helping addicts. Shorter summary

Scott Alexander explores the complexities and inconsistencies of drug tolerance in psychiatry, highlighting how different drugs can produce varying tolerance effects across individuals. Longer summary

Scott Alexander discusses the complex and often unpredictable nature of drug tolerance in psychiatry. He explores various examples of how different drugs can lead to tolerance, no tolerance, or even reverse tolerance (increased sensitivity) in different individuals. The post highlights the inconsistencies in how tolerance develops across various drugs and patients, and how this impacts psychiatric treatment. Scott expresses frustration with the lack of attention given to tolerance in psychiatric literature and the difficulty in predicting or explaining tolerance patterns. He also touches on how this unpredictability relates to addiction, the potential for missed opportunities in drug development, and the need for better understanding of tolerance mechanisms. Shorter summary

Scott Alexander presents results from a survey of 850 people rating various nootropics, showing a range of perceived effectiveness and exploring addiction potential for some substances. Longer summary

Scott Alexander presents the results of a survey on nootropics, substances that claim to improve mental function. The survey gathered ratings from 850 participants on various nootropics. The results show a range of effectiveness, with prescription drugs like Adderall and Modafinil scoring highly, along with LSD microdosing and Phenibut. Some less well-known substances like tianeptine, Semax, and ashwagandha also performed well. The survey also explored addiction potential for certain substances. Scott notes that while the survey lacks placebo control, the large sample size and consistency with previous results lend some credibility to the findings. Shorter summary

Scott Alexander explores the hidden prevalence of misery in society, using his psychiatric experience and statistical analysis to argue that suffering is more widespread than commonly perceived. Longer summary

Scott Alexander reflects on the prevalence of misery and hardship in society, based on his experiences as a psychiatrist. He describes typical patient profiles that showcase severe life difficulties, and contrasts this with the tendency of people to socially filter for those similar to themselves. The post then presents statistics on various forms of suffering and runs a simulation to estimate how common these issues are in the general population. The author concludes that the world is likely much worse than most people realize, even in seemingly prosperous areas, and cautions against dismissing the problems of any particular group. He suggests that this realization might motivate people to contribute to efforts to improve the world, such as through charitable donations. Shorter summary

Scott Alexander explores the ethics of tattling and promise-keeping, arguing for the importance of trustworthy promises even when they conflict with moral imperatives. Longer summary

Scott Alexander discusses his conflicting feelings about a patient who reported another patient using heroin in rehab. He explores the concept of tattling and promise-keeping, comparing his stance to Leah Libresco's views on breaking immoral agreements. Scott argues for the importance of trustworthy promises in society, even when they might conflict with moral imperatives. He suggests that clear consequences for breaking promises, like in ancient oaths, might be preferable to the ambiguity of modern moral reasoning about promise-keeping. Shorter summary

Scott Alexander compares his inability to allocate time for work tasks despite blogging regularly to heroin addicts' inability to allocate money for medication despite buying drugs. Longer summary

Scott Alexander discusses the parallel between heroin addicts' inability to allocate money for medication and his own struggle to allocate time for work tasks despite having time to blog. He explains that just as addicts can find money for drugs but not for medication, he can find time for blogging but struggles to find time for other tasks. Scott suggests that the real bottleneck is energy/willpower rather than time, and that blogging, being his 'addiction', doesn't require this resource. He acknowledges this is unfair to those waiting on him and mentions he should be less busy in the coming weeks. Shorter summary

Scott Alexander criticizes a study on e-cigarette effectiveness for quitting smoking, explaining potential sampling bias that could skew the results. Longer summary

Scott Alexander critiques a study claiming e-cigarette users are no more likely to quit smoking tobacco after a year than non-users. He explains why he's skeptical of the study's methodology, using a hypothetical world analogy to illustrate potential sampling bias. Scott suggests that the study might be capturing more unsuccessful e-cigarette users due to their longer period of dual use, skewing the results. He ends with a brief, unrelated mention of his addiction-medicine teacher appearing on Fox News to discuss marijuana. Shorter summary

Scott Alexander argues that e-cigarettes are likely replacing regular cigarettes rather than non-smoking, making them beneficial for public health despite government attempts to ban them. Longer summary

Scott Alexander discusses the concept of 'funging' and how it applies to e-cigarettes. He argues that e-cigarettes are likely replacing regular cigarettes rather than non-smoking, making them a net positive for public health. The post criticizes governments trying to ban e-cigarettes, arguing that while they may be addictive, they are far less harmful than regular cigarettes. Scott also touches on the cognitive enhancement effects of nicotine and his personal stance on addiction and substance use. The tone is analytical and somewhat sardonic, especially when discussing government policies. Shorter summary

A review of David Foster Wallace's 'Infinite Jest', exploring its themes, structure, and critique of postmodern society through comparison with 'Illuminatus' and analysis of its complex narrative. Longer summary

This post reviews David Foster Wallace's novel 'Infinite Jest', comparing it to Robert Anton Wilson's 'Illuminatus' trilogy. The reviewer discusses the book's themes of wireheading, competition, and the need for genuine human connection. They explore the novel's critique of postmodern society, its complex narrative structure, and its use of symbolism. The review also touches on the book's treatment of addiction, entertainment, and the dangers of self-reference. The author concludes by suggesting that 'Infinite Jest' is a postmodern work that paradoxically attempts to reconnect readers with reality through its complexity and demands for engagement. Shorter summary