This is not at all what the article says. The argument is that the current classifications don't work, and that consensual sex should never be considered paraphilic.

This funding campaign is questionable. Investors should have some access to profit and loss information before investing. I don't have a major problem with unaccredited investors jumping in and losing money, but I do think that they deserve at least minimal transparency.

I'm not far above the accredited investor line and have a few AngelList investments. They've always provided cash flow, burn rate, projected revenue goals, and how they plan to hit them. I know I can't perform due diligence and know I'll probably lose the 1-2% of my portfolio in angel investments, but I would run from any company that doesn't offer real information.

I'm a big fan of Substack and hope that I'm wrong. I just hope that trying to reach venture expectations doesn't tank what could be a fantastically lucrative SMB.

It's provocative in rats, but there's lessons from similar attempts that need to be considered. Cocaine-specific vaccines have been in development for years, and they haven't been successful. The biggest problem is that you need people to maintain an enormous concentration of antibodies against the drug so that even minute quantities are captured within seconds of entering the blood stream. Even if you can achieve an initial therapeutic levels, you need to constantly boost the vaccine to maintain high antibody titer. All of these attempts have targeted people with cocaine use disorder and are able to focus on shots every few weeks to months. We're nowhere close to developing something that would work as a routine preventative vaccination.

We do have a once a month injection of naltrexone that can block all opioids, which can be effective in the right person. A targeted approach to fentanyl alone would probably work in people who don't have an opioid use disorder (and therefore wouldn't be as prone to substitution with an alternative opioid). This is an interesting step, but our understanding of immunology is far too limited to make this realistic in the near term.

Maybe so, but I'm struggling to think of any trait that wouldn't moderate mental illness when manifest in its extreme.

I can't say enough good things about my induction cooktop. It's as responsive as gas, but puts out more power than a home gas stove. Plus, it's incredibly easy to clean. Love it.

Which is how people think clinically. Schizophrenia spectrum disorders are the most common forms of lasting psychosis. Psychopathy isn't related.

Psychiatrist here. This is true, and most people find recovery eventually without a formal program. Working with a doctor can make it much less comfortable in many cases--and in the case of opioids, can offer several options that can be lifesaving by preventing return to use and overdose.

"This is terribly wrong information, to the point of causing more harm to people who take it seriously."

^ this is generally correct for many of the classes of substances mentioned; however, it is also terribly wrong information concerning Opiate withdrawal.

I'm not sure in terms of case numbers - people can and do die from Opiate withdrawal due to vomiting and diarrhea leading to dehydration and/or heart failure due to elevated sodium levels.

This is clearly very preventable from a harm reduction perspective with the correct information.

Correct, dehydration-related complications are possible during opioid withdrawal, and I agree that it's hard to put a number on cases. The other significant risk is suicidality, which is very common during opioid withdrawal. In general, I tend not to recommend full, rapid, medically-supervised (or unsupervised) withdrawal from opioids, as the best option for most people is a transition to opioid agonist therapy with buprenorphine or methadone--which have profound mortality benefits. There are always exceptions--especially in people who prefer antagonist therapy with long-acting injectable naltrexone--but agonist therapy has the most data.

Psychiatrist (and addiction psychiatrist in training) here. I agree that calling substance use disorders a disease is highly problematic. However, I think that while the majority of people who use substances don't have a problem, there are many people who use substances in a maladaptive (or disordered) way that dramatically impacts their ability to function, and we need a name to describe that. Substance use disorder is a pretty neutral term, and much better than the older "abuse" and "dependence" terminology for a number of reasons. The wording isn't intended to suggest that personal responsibility isn't required--and any treating clinician would quash that idea right away. It's a way to describe patterns and determine what might be helpful for an individual. It's certainly imperfect, but a much better description than past nomenclature.

Thanks for replying. I agree with what you've said, and agree that it's helpful to have a term for use that dramatically impacts a person's ability to function. "Use disorder" here does seem to be a reasonable, neutral term for differentiating between normal (or even heavy) use that doesn't cause significant problems and use (at any level) that does cause significant problems (physical, mental, financial, or social).

I have a knee-jerk reaction to calling problematic drug use a "disease". "Disorder", as you've described it, does seem like a reasonable term.

Agreed. This paper https://www.nejm.org/doi/10.1056/NEJMra1602872 (which isn't available open access, unfortunately) argues that the brain changes in substance use are more likely normal learning associated with very strong stimuli than actual disease processes. I find this to be a more helpful, optimistic, and accurate interpretation of the data than the disease model. (And it really complements the other evidence-based interventions for substance use disorders we have!)

More accurately, I might say it's a protestant Christian app, whereas Mormonism considers itself restoration Christianity and may not fit as well here.

Saw this on 3/31, and got really nervous for a moment that I'd have to pay to copy and paste. (I tend to only copy and paste syntax that I can't remember. Anything more complex tends to be risky.)

Same here, my timezone is -3, I guess stackoverflow developers should create a stackoverflow question "how to check if it's a specific day in the client in the local timezone with javascript"