Much has been said about the GLP drugs and their interactions with all kinds of addictive disorders. Alcohol, drugs, even gambling... Anecdotally, I "struggled" at times with gaming (not joking). I would find myself skipping meetings at times or ducking away to play online sometimes. It never became a real issue but I knew I did it and it was embarrassing.
Once I started on tirzepatide, and then with retatrutide, the "urge" to swap over to my PC between meetings and load up a game is pretty much zeroed out.
Is this an "addiction" or a form of "abuse" similar to alcohol or other drugs? I would have said no some time ago, but now I'm not sure. I definitely feel like, looking back, I was more or less "addicted" to video games. I don't want to romanticize it as some sort of "escape", it just is what it was.
This was an unintended side effect (benefit?) of the drug for sure, in addition to acute weight loss of course.
Unlike many others, even after titrating down and coming off the GLP's, I have not felt the urge to binge food, video games, or anything else. I maintain a healthy, active lifestyle and have kept my weight exactly where I prefer it. My relationship with my body and my time has massively improved. I feel like I am at risk of sounding like a complete shill, obviously, but in my mind these drugs can be something that absolutely has the potential to turn life around for many, many people.
I think it's probably still useful to distinguish addictions with hardcore substance related barriers to quitting (think withdrawals) from addictions where the barrier is a lack of dopamine or serotonin or simple habituation.
For people with normal executive function, the second category of problems should be fairly tractable to overcome, whereas the first is still quite difficult.
The second only really becomes an issue when you have a bit of executive dysfunction.
Maybe that distinction is important and one merits the term addiction while the other doesn't? Though both categories seem to be relatively treatable with drugs that massively improve executive function, so the parallels are pretty glaring.
Most of the addiction literature I've read says that physical addiction is overestimated: even heroin addicts regularly go through physical addiction, either involuntarily because they can't get it, or voluntarily (through treatment efforts, or simply deciding to sober up for e.g. a wedding or other important event). What makes them addicts isn't that they can't stop, it's that they start up again.
Conversely, people hospitalized for something acutely painful often get addicting (or, withdrawal causing) painkillers in amounts and at purities street users can only dream of. And once it's over, they go through withdrawal, and it's deeply unpleasant, and they never want to do it again. People going through something like that aren't more likely to become opioid addicts than anyone else, according to old study results (I may be able to dig them up if you're interested).
It's of course different for chronic pain. But then, the reason for people wanting to start up again is pretty obvious.
> painkillers in amounts and at purities street users can only dream of.
It’s true that pharmaceutical purity is higher, but it’s very much incorrect to say that hospital patients routinely receive higher amounts or doses than street users.
The doses used by chronic opioid, benzo, and stimulant addicts can be absolutely insane compared to even high doses given in medical practice. Even more so after tolerance builds.
This can be a real problem for severe addicts who become hospitalized or end up in the ER because their tolerance is so high that even the high end of doses used in normal patients may do next to nothing in patients with severe addictions.
Addicts also have several factors contributing to the increased severity of their condition: Their route of administration is designed to maximize the ramp up of the dose, which leads to stronger effects, habituation, tolerance, and withdrawal dynamics.
Undergoing many cycles of habituation and withdrawal (missing doses, running out, or just abusing on weekends and trying to stay sober during the week) can actually sensitize addiction problems and exacerbate the problem, even if the doses are not extreme. This is not a problem in a hospital where doses are scheduled and regular.
Finally, the duration of exposure and area under the curve is dramatically different. An addict may be exposed to 100X or 1000X as much of a drug over years due to higher dosing and long term addiction relative to someone in the hospital who undergoes a procedure and then is tapered off.
It’s really misleading to compare opioids or benzos prescribed in a controlled hospital setting to the use by addicts. They are so dramatically different that you can’t compare the addiction and withdrawal dynamics at all.
It's the same compounds, though. And we're only comparing them on one dimension - simple physical addiction. How misleading can it be?
As I said, the studies are old. With the rise of superpotent synthetic opioids in the illegal market, and probably more caution in hospital use - one of the reasons these studies were made, was probably that someone noticed "wow, they sure used a lot of opioids during the Vietnam War, I wonder if that led to a rise in street addicts?" It's possible that it's no longer true that patients get much higher doses than the typical street addict. But it used to be the case, at least, and we can still learn from what we observed back then.
I think there's still plenty of support for the conclusions, that addicts can beat physical addiction, but that they start again, and that the fear of withdrawal pains is not a big factor in what's keeping them as addicts.
Pretty misleading, to be honest. As the parent comment to yours said, the ROA + dose schedule + AUC + peak plasma concentration differ so vastly that "its the same compounds" almost doesn't matter.
The differences between street/illicit use and hospital use are so extreme even just from a physical point of view that it is unreasonable to compare the physical addiction/withdrawal they both cause.
That being said, physical addiction/withdrawal is definitely only one piece of the puzzle of why addiction happens and addicts don't stop their use. I think that using the data of hospitalized patients being able to push through it isn't as strong as an argument for that as you've made it out to be, but that doesn't mean it isn't true.
Addiction is a very hard problem, and I'm hopeful that we'll continue developing new treatments and support methods as a society, even if its semi by accident like with GLP-1s.
I think I have heard the same. People whose lives are hopeless are much more likely to get addicted. The addiction then makes their life worse which causes this downward spiral of despair.
People with physical addictions can choose not to use drugs etc. Smokers can take 12 hour flights and they don't involuntarily take out a lighter and cigarette and smoke half way through. It is about self control.
With my limited second-hand experience, I tend to think it's less about self-control and more about the hopelessness you mentioned earlier - addicts seem to be exactly the people who for various reasons attach very little value to "being a healthy and productive member of society".
> addicts seem to be exactly the people who for various reasons attach very little value to "being a healthy and productive member of society".
These are just the people you notice and see because they don’t care that you see them that way.
My friend worked in the rehab industry. The people who attended rehab came from all different walks of life. Many of them had everything going for them and great lives. It was common for people doing well in work and their social life to think that they could abuse drugs because they could handle it better than “those people” and they wouldn’t allow their use to get out of control.
The idea that addiction is only ever a response to life circumstances is a myth. Lots of people get tangled up with drugs simply because they’re seeking some extra recreational value or euphoria and don’t think the addiction part will apply to them.
In fact, I think the idea that addiction only happens to people who aren’t good members of society is a contributor to many of these people dabbling with drug abuse: They’ve heard so much about addiction only happening to people of poor morale character or who are victims of their circumstances that they think they’re not at risk for addiction because they don’t fit that description.
I agree broadly with everything you've said but I think that you're unnecessarily implying/attempting to isolate it to a single cause, and I think it makes more sense as a variety of causes, all of which can contribute to what creates an addict:
* A lot of people who have broadly good lives get into trouble because their particular blend of biology and mental health makes them vulnerable to addictive behaviors, but others use those same drugs without issues
* People with poor life circumstances (and certain mental health conditions like ADHD) are more susceptible to addiction because they have rough lives and anything that gives you dopamine, be it exercise, casual sex or drugs has the potential to cause addiction, and people in those circumstances utilize behaviors for dopamine release more frequently and readily, and also have a stronger lack of dopamine when they stop
It's a very complex subject that's still developing, but one thing I think we can say for certain is that stigmatizing addicts and addiction and treating the people struggling with it as criminals doesn't solve anything. The criminal penalties for drug use and sale have never once helped anyone. What does seem to reliably help people struggling with addiction, any addiction, is support and safe places/drugs to use. And if GLP-1s can enhance that, I'm all for it.
And, it wouldn't hurt to change our society somewhat so we have fewer people on the bottom rungs of it, barely getting by due to whatever circumstance, whom are then less likely to get in trouble with drugs broadly. And to legalize drugs, because making them illegal doesn't do anything apart from inflate police departments' budgets, and push people who want drugs into dangerous situations, addiction being among them but not the only one.
“Lack of dopamine” isn’t an accurate description. It’s a reductionist pop culture metaphor that feels scientific but it’s not really accurate. Drugs of abuse involve multiple systems including opioid receptors, which modulate reward. There is much more going on than simple levels of a single neurotransmitter, which can actually be completely normal relative to non-addicts. Dopaminergic systems are actually involved in driving certain addictive and craving mechanisms, which should be a hint that it’s not as simple as “lack of dopamine”.
In fact, the side effects of certain drugs that directly increase dopamine levels (L-DOPA) or drugs that directly stimulate dopamine receptors (dopamine agonists like bromocriptine) include a risk of compulsive gambling, shopping, and risky behaviors.
Ironically it’s more accurate to simply say “withdrawals” than to try to inject reductionist neurotransmitter speak.
What do you now do instead of gaming? Do you find you have swapped for a different activity or a more balanced allocation of time among other things? Or do you still spend your off hours in the same way, but kicked the compulsion for gaming all day?
I do the work I probably should be doing, or side projects, or spend time with my kids, or go on a walk, or follow up on that thing I've been putting off, or any of the other million things that are more productive and fulfilling than video games are. It's embarrassing to admit that I was a grown man who would put off basic, important tasks just to play games but I did. Now I don't.
It's not even really about choosing not to, either... it really does feel fundamentally like I cannot even derive a dopamine response to video games at all anymore, period. Same could probably be said about doom scrolling social media or whatever else. I just get no false positive feedback loop from the act.
If it works for you keep it up. As someone who finds video games an art form I find the 'avoidance to do better things' quite similar to someone who might avoid reading or watching movies as a hobby.
I suppose if you just play the same game day in and day out and it has no real substance (which admittedly is probably the largest gaming segment) it might be a good thing to get rid of the habit. But some games are masterpieces and they often hit very different than other mediums because you are the protagonist making choices. In my opinion some of the best stories come in the form of games and I find it a real shame there's a portion of the population who think they're a complete waste of time.
I think there's also something to be said here about being addicted to work. I know such people and it's just as sad even if it's what society expects of them.
You can't judge someone for not liking a certain hobby. I spend a few hours gaming before bed each night after the bare necessity chores are done, but I have a nagging feeling in the back of my head that there are better things I could be doing with my time, and that's a healthy feeling. I've also had a time in my life where I spent almost all of my awake time trying "artistic" unique indie games, all very highly reviewed and well-made, and while yes, it is a unique and enjoyable art form, it still felt empty in a way. It's still all just pixels on a screen. Yet another Unity game. Yet another fetch side quest. Meanwhile I was unemployed and too depressed to make a good effort at applying for jobs, my self esteem so low that I felt nobody would hire me, living in a crappy old apartment in a crappy part of town, a major downgrade from how my life started.
I don't judge people for it necessarily but I sometimes wonder if they have the wrong idea about what games are. There definitely are problem games that are essentially gambling addictions manifest so the stigma is sometimes warranted. If you sit around playing the same dungeon in a Diablo game 8 hours a day trying to get an item that raises your power 0.5% you're probably off the deep end. But playing something like Clair Obscur or Elden Ring gives me a very unique experience that eventually ends. And the game ending / not wasting your time too much tends to be criteria I use when choosing games as well.
If you look back on that time of low self-esteem and a crappy life I bet there was a myriad of other things causing it and games were just your drug of choice for 'dealing' with it. At least that's my experience. And IMO if your life avoidance drug is games instead of almost anything else (alcohol, marijuana, etc.) you're probably doing better than most in such a situation.
"It's all just pixels on a screen" isn't really an argument for me because my work life, much of my social life, and almost every other form of entertainment that isn't video games (including what I'm doing right now) is all just pixels on a screen as well. And playing games with friends that are across the country or a few hours away is absolutely the best way to be social with them possible. Hell even when I go on vacation I make damn sure I capture pixels on a screen to look at later.
I think the context here is important. regardless if videogames are an artform
or not. putting off work, parenting or whatever are priorities in life to get a videogame fix is not the same as playing video games in your leisure time when is not an impulsive decision
That is true, and if something like gaming (or reading, or playing sports, or building model airplanes or whatever other passion) actively interferes with your functional life, that's a huge problem. But there is nothing wrong with taking a day off work to play a new video-game that just came out, if that's your passion, even if it's "putting off work", or similarly in having someone else look after your kids for an evening to enjoy some gaming. Adults very rarely have alloted leisure time where they can just pick an activity. There is always something "more productive" you could be doing instead of pursuing a hobby, especially if you have kids. That doesn't mean that any time you pursue a hobby instead of one of these activities you are being irresponsible - there must be a balance. All work and no play, and all that.
Fully agreed when it starts interfering with your life you should reassess as with anything. But honestly I see gaming as a further place to connect with kids if you enjoy them. Something like Animal Crossing, Mario Kart/Party or Jackbox Party Pack can be some of the best bonding experiences out there. And it also lets you teach your kids how to have a healthy relationship with games/dopamine.
It depends on degrees. If you're going to lose your job and your wife is about to leave you stop doing it. If you just did 12 hours of work/chores/put the kids to bed and want to relax with a bit of gaming? Some people would still feel guilty but I haven't a clue why.
Can't speak for OP but I largely spend it reading (and web). I bought a kindle recently because I found the ipad/iphone were too distracting to reliably avoid web surfing instead of a book. I view the switch to long form content as a form of information dieting in the same way as a switch to whole foods.
Maybe try NAD+ boosters next? They seem to be reducing addictive behaviors quite a bit. Liposomal NAD+ or nicotinamide riboside or IV NAD+. The theory is an energetic deficit in the brain that drugs/addictions seem to override temporarily but deepen long-term and NAD+ is essentially bringing the energy back. Maybe GLPs do something similar due to flooding the body with broken down fat?
Not the person you asked but I have good data - I lost 32kg over 6 months on tirzepatide, 11kg of it was lean body mass, the rest was fat (based on DEXA scans).
In general, lean body mass loss is more of a result of rapid weight loss (I certainly consider mine very rapid), than result of the medication itself. If I was able to lose the same weight in the same period of time without the medication, and kept my protein and resistance training the same, I'd expect a similar ratio of muscle/fat loss.
Overall extremely happy with the outcome, very grateful that these drugs exist and that I was able to access them.
68lbs over 9 months for me on Tirzepatide. No exercise (I should, but I'm traveling an absolute ton right so consistent exercise hasn't been prioritized).
> This was an unintended side effect (benefit?) of the drug for sure, in addition to acute weight loss of course.
Is it possible that video games were your escape from a world in which you were obese, with all that it can entail, and losing the weight removed the need to escape?
Not true for everyone, or perhaps even most playing in this space.
Every batch friends of mine have ordered has been independently tested for purity and dosing. Random batches also tested for sterility.
Plenty of folks yolo it, but it’s not like it was a couple years ago. Lots of group buys being done that order a large batch and then do random sampling for lab testing.
Not to defend buying research chemicals of unknown safety, but that isnt what he said. Independent labs test for purity and provide certification to the companies that sell them. Those certifications can be verified by anyone. So its much less trust necessary to know what you are getting.
League of Legends is “used” by a lot of people as medicine. Nobody hides away to play Stanley Parable. Lots of games, lots of genres, difficult to generalize.
from what I saw people on GPL still eat as much as they can, they just can't eat as much due to the feeling on "fullness" setting in fast. They seem to push the boundaries further the longer they are on it though, so there seems to be some habituation to overcoming the "feeling full".
I guess if you can get addicted to work instead of video games, etc companies will start negotiating with GLP-1 drugmakers directly and make them widely available.
I think it depends. With tirzepatide (my first encounter with GLP1 meds) I got acute appetite suppression, perhaps too acute. I living comfortably on sometimes 1500 calories or less per day, and I track my calories religiously. We are talking maybe 1 cup of yogurt with frozen berries in the morning, and 1 whey protein shake around 3pm (Fairlife milk + 2 scoops whey) and I would be absolutely full until bed. No energy deficiencies to note. I worked out regularly 5 days a week.
This caused rapid weight loss. A side effect of this rapid weight loss and lack of food intake I also attribute to my thinning hair and dry, splotchy skin outbreaks. Any sort of overeating on tirzepatide (for me) caused severe sickness, or nausea.
Retatrutide, by contrast, causes far less pure appetite suppression (my dosage is also lower) and has another mechanism which helps me maintain leanness while also eating extra calories. I think I prefer the reta, but if I ever felt the need to very simply destroy my appetite again I wouldn't hesitate to use tirzepatide again.
I procured both tirzepatide and retatrutide through the peptide "grey markets" so one was not harder to come by than the other.
It could also be simply that as you lose weight, you have more tonus (something that I experienced myself), and activities that are inherently passive (watching TV, playing videogame) seem less relatively compeling than more active alternatives.
I'm going to put on my Boomer pull-yourselves-up-by-the-bootstraps hat, but are you concerned about the loss of grit resulting from changing your behaviors without the drug?
Definitely not GP, but I think it’s pretty clear that whatever grit there was to have, GP did not have it. “Die an early death due to being overweight or build the grit” is strictly worse than “lose the weight without building the grit, or build the grit”, and it’s even more so when you realize that “or build the grit” was never in the cards. Because then the choice becomes “die an early death or don’t“. Building the grit can be done on other, hopefully less lethal, projects.
Preface: I'm going to sound quite harsh by changing scales, so put your tough skin on before continuing.
This is certainly worse for the individual, but at society scale, the cost being the obvious devaluation of willpower is way too high. Way too high because everything good in that society was built almost exclusively by driven and strong-willed individuals.
I'll give a reply a go - of course we want strong people. That said, we've introduced incredible amounts of weird new things to the world. Advertising, shit food, tech, and a litany of responsibilities. Some of these are very bad and we all paying heavy prices for it.
I don't think we need to treat every bad thing society does as only needing a "toughen up" solution, instead we should fix the root cause.
An extreme example would be if the government poisons your water, maybe some medicine is ok. We should un-poison the water too, but I'm ok with medicine in the meantime.
Then we should start selecting strong willed individuals who do not fit into the “normie” path as those we uphold and show to be role models and examples.
Instead we collectively shit on them and force them into the most useless lifestyles ever devised - effectively pushing paper on rigid schedules or they don’t get to eat.
I’ve thought about this one quite a bit. The world has narrowed a whole lot to define acceptable behavior and who is allowed a seat at the table.
Almost all those “strong willed” individuals of the past who actually built things had lifestyles that would have gotten them entirely shunned from society today.
It’s not impossible but even compared to 30 years ago it’s an entirely different world for such folks. The way I “came up” in life would not be possible today due to the gatekeepers of “respectable society”.
Needing drugs to fit into that incredibly narrow and basic framework of a life should be of no surprise to anyone. Only a few of incredible luck and willpower and probably even naivety will survive that filter.
This whole topic is the epitome of “show me the incentives and I’ll show you the outcome” - entirely predictable, and it’s what society seems to want.
Expanding on what a sibling comment said, we live in an adversarial environment. A successful food product is one you want to eat, whether you need it or not.
Willpower is important, I agree. Almost everyone needing willpower to not eat, though, is a fairly new phenomenon. If anything, the new drugs restore the balance that existed before —and if willpower is a limited resource, actively help society by returning to us what is taken by the relentless grind of profit maximization.
Willpower to not eat really isn't the same as willpower to eat reasonably (in quantity and quality), though. There's even exercise to offset the effects of suboptimal alimentation.
Either willpower is fungible, in which case it doesn’t matter what you use it on because you’re using it up no matter what, or it isn’t, in which case the original point about losing willpower due to leaning on GPL-1 inhibitors for weight loss is mostly invalid, since it wouldn’t affect the willpower to do other things.
The loss I wrote about is society-wide, not for individuals. Weak-willed people won't change, the problem is the damage to people who have willpower but are basically told it doesn't matter.
It's really a matter of incentives and proper valuation.
Maybe if moral virtues can be purchased they were never moral virtues to begin with?
Many moral vices naturally decline with age as physical senses and hormones dull and life loses novelty. It may be a comforting fantasy that we can somehow link our inevitable physical decline to a story of moral progress and assume that our accumulated wisdom would protect us from the folly of youth if we were somehow thrust again into our younger bodies.
But what if instead moral progress is about finding the right way of living? About spending more time with your kid than with a screen.
Maybe the virtue wasn’t in getting over the wall but finding yourself on the other side and choosing it because it is better? Society puts up walls all the time to prevent people from finding themselves on the wrong side of the wall. Nobody ever talks about the “grit” of the addict persistently dodging law enforcement to score their next fix.
Maybe the problem is society putting walls in the wrong place. If that’s true, does it really matter how you get over the wall?
What do you mean "grit"? Does doing something more efficiently mean you lose it? What's the difference, say, between someone using an LLM to help them code and someone else using a drug to help them diet? Is the coder using an LLM losing their "grit"? Do you walk to work in 30 inches of snow, uphill both ways, in the rain? Are you concerned about your loss of "grit" by not doing so? This argument continues to baffle me.
I didn't take the GLP to help me with addictive behavior traits beyond my diet, but I observed tertiary benefits of the drug.
As I've titrated my dose down to zero, I've retained those habits and my weight. I'm in the best shape of my life and mentally healthier than I've been in over a decade.
I think the comparison to LLM use is a bad idea, because LLM use has pretty clear adverse effects on your capacity to program unassisted, and almost certainly long term limits your potential growth as a programmer, in ways that the LLM can't compensate (at least, not with current tech). Basically using LLMs extensively as a junior may well make you a better junior, but guarantee you'll never be a senior.
My understanding is that that GLP1 drugs don't actually have this effect, as much as we know so far.
If I can change my behaviour and achieve good health outcomes, relatively painlessly, why on earth would I not?
This comes across to me like people who won't use painkillers - I should feel the pain, masking it is fake, there is virtue in suffering etc. Turns out those people often end up with secondary complications to (for example) muscle damage, because they've adapted their movements so much to avoid using the painful muscle that now everything else is tense, strained and locked up.
Not the GP, but do you think Serena Williams - world number 1 womens tennis player for 319 weeks, who trained for 5 hours per day at her peak - has insufficient grit?
Grit, or willpower, or whatever you want to name it isn't a unique, constant value. There are plenty of athletes who could spent hours training every day but are overcome by addictions. People who grind at work but cannot fill paperwork to save their life. That will diligently do something for months then stops after an unexpected interruption.
There's probably generally a bit of correlation. But just because someone can be very focused and go to extreme lengths in one aspect of their life doesn't mean they can consistently do it in every aspect of their life.
This would be my suspicion as well. Once upon a time, diseases like scurvy, leprosy and cholera were described as caused by insufficient moral fibre of the patient. Maybe this sort of moralizing is the best indicator that the underlying cause of the disease is, in fact, unknown yet.
The current scare mongering over an "increase" in Autism rates is entirely driven by the fact that we stopped diagnosing autistic people as having other intellectual disabilities
Done by the same people who demonstrably treat ADHD as just "laziness"
What if it were possible to get grit from a pill? People who have taken it and come off of it are saying that they haven't reverted. You get good at what you practice, which is as true for grit as it is of anything else. If some people need assistance in getting that practice, this can probably help them. I've taken ritalin for ADHD for a long time, and if I don't take my treatment, I'm still far more focused and productive than I ever was before treatment, because I developed habits through the medication that stuck. I wouldn't be surprised if something similar were at work here.
I think this is a valid point, and the reason I haven’t tried these drugs and don’t plan to. There are huge benefits to developing the mental strength and discipline to lean into discomfort consistently and just do what needs to be done- and all types of addiction provide one of the hardest, and therefore most valuable and useful obstacles here. As Marcus Aurelius said “The impediment to action advances action. What stands in the way becomes the way.”
I’ve found that the general act of leaning into challenges and mild physical discomfort has a ripple effect on my mind, and all types of addiction and dopamine seeking behaviors become automatically less interesting- almost exactly like what people report on these drugs. If I take a cold shower or work out every morning even when I don’t feel like it- pretty soon I’m eating healthier and limiting my alcohol, caffeine, and screen time without even really trying to.
That said, it only works if you manage to actually do it. It’s much better to get over addiction with a drug than to continue suffering from the addiction, and be unable to escape, especially something that causes as much damage as alcohol can.
One idea I had was to set a deadline for overcoming an addiction, and to just use the drug if you reach the deadline and the mental approach is still unsuccessful.
I wonder if you have more ”grit” than Sugar Ray Leonard, one of the greatest boxers of all time. His fight with Roberto Duran are legendary.
As so many boxers (and many athletes for that matter) he was addicted to drugs and alcohol for many years. Probably sexual abuse he suffered as a kid had something to do with it. He was able to quit, but I think cold shower and a run in the morning was not quite enough to do it.
Nobody just starts abusing their body with chemicals. It is not difficult to quit, you can stay off your Jones for months, but if you do nothing to the demons that made you enter the 36th chamber in the first place, you are going to slip sooner or later. It takes more than a splash of cold water on the face.
Marcus Aurelius was literally a god and the emperor of the world. He prob had little bit more resources to help gim other than stoism. Similarly if you have loving family and friends, a good therapist and some sort of medication,you canmaybe wim the fight with the devil that gets you to use. Training and getting used to being uncomfortable surely helps, but you won’t kick anything for long only with them.
Therefore these drugs won’t be a solution either. Are you going to use them rest of your life? Whatever it is that makes you want to drink, smoke, shoot, gamble or whatever is still going to be there. Bit used together with therapy and loving environment might help. Of course, most addicts have no access to any of these resources.
I agree with all of what you said, and I'd argue that the stoics including Aurelius probably would have as well. Leaning into discomfort is just a step that can help you actually do things like get therapy and be present and engaged in a loving environment. At least for me that's the case- I have seemed to need all of those things together as a system to really thrive in life, not just one or the other.
CBT and ACT are modern therapy methods based on stoic methods, very widely used, and very effective for regular people that aren't emperors.
They are most often effective if you can afford them was my point. I have ADHD as well and boxing (waking up before work to run in cold November morning, 9 rounds with a heavyweight who had nobody his size to spar, thousand ab movements afterwords and hey it’s only Tuesday) helped me tremendously with focus, staying of the booze and so on, but if I had not done years of therapy and had meds as well as found more varing environment, I prob would no be hete. And I was lucky to have a god job to pay for all that.
I do think you need tremendous mental effort, or grit, even to fight serious addiction. But it is only a start.
CBT effectiveness is highly overstated, from anecdotal experience and talking with psychiatrists in a social setting.
It works for a subset of the population that doesn’t question stuff too much and is more or less ok with gaslighting themselves. There is evidence that it loses effectiveness the higher up the IQ scale you go.
The vast majority of mental health issues are a “not treating the root causes” problem. People stuck in a life they despise for various reasons and have no realistic way of changing those root causes. This ranges everywhere from the single mom with 3 kids and an eviction notice all the way to the high powered corporate executive stuck in an empty do-nothing career path.
Not everyone is wired the same but we’ve created a society that you must conform to extremely rigid norms or be at risk of destitution.
Not doubting your expertise, but I am skeptical of the idea that this method of intentionally leaning into discomfort only works for some minuscule abnormal subset of people that are just wired differently. Instead, I suspect it's tapping into something deeper about how our reward system is structured, something extremely related to how these GLP-1 agonists work, which explains why they are both effective against a shockingly wide array of seemingly different situations.
The basic idea seems to be at the core of both a lot of modern self help gurus advice that seems to actually work for a huge fraction of the people that really commit to them (David Goggins, Wim Hof, etc.) as well as modern psychotherapy systems like CBT and ACT that are proven clinically effective.
How many people are really trying this approach, and it not working for them? More often, I see people saying it sounds like it royally sucks (which is true and basically the entire point), and never trying it- which is valid, but doesn't really demonstrate that it wouldn't work for them.
It absolutely is a "nociceptive hell" at first for everyone that tries it, but when you connect that with intention, purpose, and meaning it eventually transforms into something almost enjoyable. Becoming strong enough to meet discomfort or pain feels amazing, especially for someone that usually experiences the opposite of that.
I also have ADHD, which is explained in part as a developmental disability of executive control, but I find this approach to be extremely effective for regaining executive control, even to levels that people without ADHD lack. Basically, I suspect ADHD isn't a loss of executive control at all, but the executive control is being blocked by something like the feeling of pain or drug withdrawal, and that once you are okay with just having that bad feeling all of the time, you get your executive control back. I'm curious if GLP-1 drugs also help with ADHD? My prediction is that they would.
Can you define huge fraction and really commit? And cite evidence?
I disagree the basic idea of CBT or ACT is leaning into discomfort. In the senses articles suggest David Goggins and Wim Hof advise even less.
CBT and ACT work for many patients and don't work for many patients.
Some people liked intense exercise their whole lives. Some people hated it when they started but liked it eventually. Some people exercised daily since decades and hated every minute. Do you not believe the 1st and 3rd groups?
Pushing through bad feelings is a form of executive control. And ADHD impairments are not limited to impulse control. People who have ADHD who do not take medication have significantly higher rates of driving accidents than people who do not have ADHD or take ADHD medication. Proprioception, internal time perception, and working memory impairments are common.
> I disagree the basic idea of CBT or ACT is leaning into discomfort. In the senses articles suggest David Goggins and Wim Hof advise even less.
I am somewhat baffled by your statement, as I feel it is largely self evident being familiar with, and having tried both therapy methods with professional therapists, and both Goggins and Hof's advice for years. I think a simple wikipedia level explanation of what those things actually are would suffice to answer your question, so I have nothing major to add, unless I am misunderstanding you. Goggins whole shtick in particular is just this one basic point, make yourself as mentally tough as possible by intentionally always doing whatever is difficult. Hof is also just literally getting into very cold water consistently, which is really not easy- and he has no real philosophy or theory, he just has you do it and see what happens.
Perhaps the therapy methods are less clear, but reframing things or deciding on clear values and purpose, are in my view, psychological tools to make the difficult endurable, or in some cases even enjoyable. This makes more sense if you're seeing the methods in the context of how the ancient stoics used the same techniques that inspired those therapies- especially Epictetus.
> Can you define huge fraction and really commit? And cite evidence?
Not really, it's just firsthand experience from doing them, and having widely sought out and read the experiences of others that did online.
In other words, gathering your own anecdote, compounding that with other anecdotes through biased sampling (which kind of person will feel more motivated to share their anecdote on it? And which and anecdotes do you reject because they just didn't try hard enough?) and then projecting that onto every other human being and assuming they must experience the same thing you do.
I never claimed it works for everyone, I am doubting that it is a provable fact that it works for only a minuscule fraction of people- I am not sure exactly what fraction of people this would potentially work for.
You are effectively implying that firsthand experience and expertise are completely worthless, and people can only learn information from large scientific studies, which is nonsense- it would invalidate virtually everything humans know that allows them to effectively navigate the world. I'm a working academic scientist that often designs and executes large studies, and I only ever see these arguments and line of thinking from non-scientists that don't actually understand the limitations of scientific methods, but have turned it into some sort of pseudo-religion.
These are effectively yoga/meditation like techniques that are taught in communities I am part of, and that I have taught to friends and family. I'm not under some delusion that there isn't bias there, I have seen it not work for people, and account for that in my thinking about it. It's been life changing for me, and so I am happy to share info about it in case it might be for others, but I'm not under some delusion that it is the solution to everything.
Correct me if I'm wrong, but I get the impression that your comment isn't really about what I am actually saying, but a general anger towards anything that looks like "pulling yourself up by your own bootstraps"- an anger you can see in other comments in this thread as well. This toxic line of thinking comes from an old fashioned moral argument, that basically derives ones moral standing and worth as a person from the state of being helpless and persecuted, which requires one to actively fight against anything that might be an effective tool to overcome adversity.
I don't agree that using techniques that can help people overcome adversity in any way diminishes the challenges people face, or diminishes things like systematic injustice and addiction that certainly can be due to factors outside of one's control, and hard or impossible to overcome.
Having tools and methods that can, even sometimes, empower people to overcome, survive, and thrive, even if they don't work every time doesn't invalidate those problems, it is just one way to fight them.
“I am skeptical of the idea that this method of intentionally leaning into discomfort only works for some minuscule abnormal subset of people that are just wired differently”
That may be the aspect of this line of thinking that’s not clear then: it doesn’t work for anyone. At least, in so far as the free will is illusory, it is a hallucination that such people have that they made such decisions, and stuck to them. It’s the demon hand syndrome, the person hallucinating a rationale for its motion.
The free will question seems to be a red herring- philosophers and physicists can argue all they want about if something like free will is physically possible or not, but for all intents and purposes, even without free will, the path of someone overcoming, e.g. alcoholism after using these methods requires using them in a way that is challenging, and if you decide on the nihilistic stance that there is no free will so there is no point in ever trying to do anything, then you are guaranteed an undesirable outcome.
Perhaps beforehand it was somehow "pre-determined" which of these attitudes and paths you would take, but that is completely irrelevant for the individual just living life, they have no way to know that one way or another, or any reason to actually care, as they still need to act exactly like they have free will and made the right choice to actually play out a future as the type of person pre-determined to have a desirable outcome.
It doesn't actually feel any easier or less painful to accomplish something difficult, even if free will is some sort of illusion when looked at from the outside perspective. You still experience, e.g. trying and failing over and over and never giving up until you succeed.
I can buy that, for example perhaps there is something outside our control that decides if you are capable of never giving up, but you still cannot know until you decide to never give up and try it- so it literally does not matter except as a philosophical curiosity.
I think a more interesting biological (and philosophical) question is why and how exactly do these GLP-1 drugs work, and why exactly are they so shockingly effective? Maybe they do somehow act on the brain to offer exactly the same psychological benefits as the stoic approach I am talking about, by the same or related underlying mechanism, and they're essentially interchangeable but work more often?
This topic is a great example of how results from down-in-the-weeds biochemistry immediately raise questions at the top levels of consciousness and existence.
“Leaning into discomfort” for personal change may well work for much more than a miniscule fraction of people. It may be that such success is made more likely by some structural predisposition – an attenuated neuronal response to negative reinforcement, or some other precondition that allows its “carrier” to keep plugging to a successful outcome.
But clearly, there’s also a more than miniscule fraction of people for whom that doesn’t work. Their preconditions may deflect them from even trying that particular path, or cause them to give up along the way. I really don’t know, but that fraction seems at least as significant as the fraction for whom uncomfortable personal development paths lead to success.
Early in my career, I strongly believed in free will. I mean, I had it, right? And I didn’t regard my consciousness as all that different from my fellow hominids, so they’re probably all similarly endowed, right? Except...
Over time, research with small molecules like epinephrine and the psychedelics showed that perception/decisions/will could be profoundly influenced by neurochemistry. Ditto for various neuronal illnesses that are associated with profound personality changes.
I regard the GLP-1 results as a further demonstration that “free will”, whatever that is, is fundamentally mechanistic. There are few, maybe no, organismic drives stronger than hunger. A weekly injection of a GLP-1 agonist turns that drive way, way down in most of those who try it. This commonly exhibits itself in profound behavioral modification: if you were an inveterate snacker, suddenly you’re not interested in snacks. You pass them by in your pantry and at the grocery store. Your cognition around snacking changes, to the extent that not only aren’t you snacking, but you might find yourself setting a reminder that it’s time to have lunch. Given the strength of the hunger drive, that’s a very big deal, and revelatory about how we work.
I used to think I understood “free will”. Lately, I find it increasingly hard to define. I’m moving more in the direction of Robert Sapolsky as more research results come in. It feels to me a bit like the “God of the gaps” phenomenon, in which the space available for faith in the supernatural grows smaller with every scientific discovery.
It’s a remarkable time to be alive and have the luxury of considering these questions.
Ah, you might have seen my reply to someone else addressing the free will question from a philosophical angle, but despite also being in the life sciences, I never expected you were thinking about it biochemically.
I think it's obvious that we don't have "free will" in that sense, it had never really occurred to me to consider otherwise- people are definitely quite driven by instincts, neurochemicals, etc. they they can't consciously choose.
However, I think my comment in the other thread still applies- that for an individual, it doesn't really matter one way or another- your firsthand experience is still going to be one of exercising your will to increase the odds of getting outcomes you want in life, or choosing not to, and definitely not getting them.
But there is some biological clue here about who we are, and how our brains work that is fascinating, when you consider the breadth of human health problems and challenges that these GLP-1 agonists influence. I can't wait to see what more is learned about this in the future.
Having "grit" is more likely a symptom of coming from privilege. The marshmallow experiment comes to mind. Some kids were able to resist the urge to not eat the marshmallow for the promise of getting two if they waited. Others could not. The kids that could defer reward ended up having better life outcomes. In retrospect it was a test for privilege. Kids from poorer backgrounds tended to go for the immediate reward of the marshmallow. The test really showed that privileged kids have better life outcomes than kids that don't have privilege. Not really a surprising outcome.
After I started committing, really committing to consistently working out, a lot of other things fell into place more or less automatically. I stopped drinking, started eating very cleanly (I became ravenously hungry; junk food and sweets aren't appealing anymore), and stopped spending as much time on gaming. I know your broader point is about leaning into discomfort, but specifically leaning into exercise seems to bring extra benefits. Exercise is medicine, as they say.
I think for this to work psychologically, it just needs to be something difficult or uncomfortable that you can do an awful lot of in a way that is sustainable, and doesn't actively harm you... all the better if you actually benefit directly from it, like with exercising, but cold showers work just as well, simply because they're uncomfortable and take much less time than working out- I personally do both.
The issue with addiction is, it’s very often a symptom of other underlying issues. Relapse are common because too often the underlying problem isn’t treated. Overcoming the addiction is hard because it means facing the thing the addiction allows you to avoid.
Addiction is also common(ism) amongst those who suffer from NDP. In this case, is it truly addiction, or simply another tool in their NPD cache of weapons.
I don’t disagree with you. But it’s also important to be aware of some of the nuances and finer points. I also recommend reading “The Courage to be Disliked”. Not that it / Adler speak to addiction but it’s a thought provoking alternative to the Freudian paradigm.
Getting rid of an addiction also counts as strengthening your mind in itself. A healthier mind will be in a better position to strengthen and fortify itself.
Why would you say I am falling into that trap? My comment specifically addressed the issue that it might not work, and included a specific strategy for how to not get stuck too long on the idea of working if it does not.
If people want to believe in "grit", they at the very least have to also believe in Undset's dictum: the hearts of men do not change, not in any age.
If it's an inherent quality, then there's no reason we should have any less of it than "the greatest generation", or whoever we should want to idolize. The difference has to be external, not internal.
Let's work on what we can change, the external. What you are might change, but you can't change it - that's the core realization behind both European pagan obsession with fate, and Christian obsession with sin.
You haven't understood what I'm saying. Call it grit, call it character, whatever: it can maybe be developed or change, but not on its own.
Circumstance, including other people, can change it for better or worse, but you can't change it on your own. You are exactly what you are. Without input from outside, you'll never turn into anything that isn't already implicitly there.
To explain it in computer science terms, since this is HN: suppose you have a method which takes no input. Even if it's self-modifying code, can it change into something else? Can it "improve"? No. Whatever it will turn into after overwriting its own code is essentially already there.
You have all the "character", "grit", whatever, that you started off with. If you get some or lose some throughout your life, it's from outside yourself: it can go either way, and you can't take credit for it anyway. This is something that all sorts of pagans, and Christians, have understood for thousands of years, but the modern Horatio Alger "conservative" doesn't understand it.
You appear to be saying that we have no free will because our choices are decided by us and we are the result of our environments. Your self-modifying code argument is that the result is already essentially there from the beginning because that's what the code says to do.
That is not a Christian view as I understand their philosophy. I am not one myself.
I think a better analogy would be self-modifying non-deterministic code. You cannot say in advance what the result will be. The state before execution is not equivalent to the eventual result, because different results are not equivalent to each other and equivalence is transitive. So it can indeed improve. Or get worse.
If the source of that non-determinism (or at least some of it) is our choices then yes of course those choices are constrained or sometimes determined by circumstances or our current past-determined states but that does not mean we do not have the ability to influence our future states.
We have the power to better ourselves even if we don't have the power to directly determine our internal states.
No, free will is really quite beside the point. You can believe the choice is real, whatever you put in that, but the choice will still be based on what you are, and you can't change it, other than based on either 1. what you already are, in which case it isn't really a change, or 2. Something outside of you, input.
Nondeterminism changes nothing for the argument, in fact I mentioned it explicitly already.
You didn't mention it explicitly or otherwise. Why lie? That's such a weird thing to do. I can read your comment and catch you in the lie so easily.
Free will is the entire point. You are saying "the choice will [be] based on what you are, and you can't change it". That is precisely an argument that our choices are determined, not free.
>other than based on either 1. what you already are, in which case it isn't really a change, or 2. Something outside of you, input.
You have just ignored what I said. You cannot say that you haven't changed your character because the change was brought about by your own choice, for the reason I already gave: you have free will, so your choices are not determined, so the results can vary.
You cannot say that A and B are equivalent states because B is reachable from A, when C which is clearly distinct from B is also reachable from A, and the choice between B and C is nondeterministic (free).
To make it more concrete, you have free will. You choose to challenge yourself or not by doing something difficult. That choice is free. It is chosen from among constrained options but it is still a choice. We make constrained choices all the time. They're still choices.
Some people can't afford to buy musical instruments. Of those that can, some choose to buy one and some do not. Of those who do buy one, some choose to practice and some do not. You cannot expect anyone to believe that that choice is free but also that the person that chooses to learn an instrument and practice and develop is identical in character to the same person if they had exercised their choice differently and instead sat on the couch and watched TV.
People make choices. Free choices. Those choices result in the development of their personalities, the development of skills, etc. Those choices are not predetermined by their existing character. There is no external input necessary for your character to change and yet clearly, logically, their character also was not already there. The potential for it may have been there, latently, but so what? Everyone has the potential to have good character. Everyone could be a better person than he is.
Been on Mounjaro/Zepbound for the past 2 years. Lost around 80lbs, and my brain feels like I’m 25 again. Almost no urge for alcohol and have an opened bag of Halloween candy in the closet which isn’t calling my name. But the most surprising part hasn’t been that… it’s that my no limit poker game has gotten really quite good. I’ve played for 20 years, and been well above average, but after the glp-1, something just clicked. Maybe I no longer go on tilt or something? Played in the World Series of poker for the first time last year and placed in the money, in the top 10% after having not played since before Covid. I just started playing in a house game that I’d previously played in 10 years ago. Same people, and before I’d never placed in the money. I’ve now won in 3 of the last 5 games. Something’s different. Is playing poker pleasurable? Not in the least, but a good friend invited me, and played for the social aspect, but now I’m just stunned at how good I’ve suddenly become. Disliked the World Series so much last year, that I opted against playing again, even though I expected to place again. Maybe other poker players will adopt it.
Just a single datapoint here. About 8 months after starting on semaglutide I took a month off alcohol and by the time the month was over had lost all interest for alcohol.
Almost 2 years now. I'm not religious about it and will occasionally drink the celebratory glass of bubbles or a beer (alcohol free if available) when it's hot outside.
As someone who doesn't really drink and never has alcohol at home, is it just that people buy beer/wine and drink on a daily basis for fun? The wine I feel like you can pair with food and feel classy as an excuse but beer that ain't the case.
I realize how completely dumb this question might sound.
> As someone who doesn't really drink and never has alcohol at home, is it just that people buy beer/wine and drink on a daily basis for fun?
Yes, anything from a couple of drinks a night with dinner / tv to getting blackout drunk multiple times a week, alone, with your significant other, or with friends / roommates.
In the case of people in my social circle (late 30s early 40s) it's primarily still for fun, as well as just a large amount of momentum from your teenage years, 20s, 30s, etc. For a lot of people I know, the association between drinking and good times / relaxation has been deeply engrained since high school.
I've recently taken an extended break for my health, as I'm fully aware that it takes a toll on me, but I still love grabbing some drinks whether I'm relaxing alone in the evening or going out with friends and family.
While it's certainly true that many people get into a dark place with drinking and let it spiral into a self-destructive, depressive pursuit, I don't think it's quite the rule it's made out to be.
I have a good amount of family who live idyllic, full, happy, social lives, drinking heavily multiple times a week with their friends and family into their 70s/80s until death.
When drinking small quantities, it's more to relax/unwind at the end of the day than to 'have fun'. Sometimes it's self-medication for stress/depression.
But it can easily escalate into a rather unhealthy habit. And even fairly small amounts can disrupt sleep.
I'm not trying to pick on you because I've seen this anecdote on many occasions; however, it strikes me that people are quite willing to walk past "personality changes" as a side effect of a drug.
Does anyone else feel a slight sense of worry about this?
I don't know much about the drug, maybe you're talking about something else... but FWIW, I got sober from years as a practicing alcoholic the traditional way, I had lots of personality changes, some good some bad, but who I was when I was drinking all day every day and who I am today are quite different people.
I don't think it's a personality change, at least insofar as personality is separate from neurochemistry. Ghrelin and dopamine are strongly linked, and dopamine is our central reward-seeking driver; GLP-1s generally reduce ghrelin production, which I suspect helps remove you from a state of being constantly primed for reward-seeking. I noticed this firsthand when I went hard keto for the first time, and could suddently for the first time tell a significant difference between "I want food because I'm hungry" and "I'm not hungry but want food because it's pleasurable".
I worry about it. I do tend to wonder if it can change your relationship with addictive and maybe risky behaviors, does it also potentially make you into a more conservative (not politically) person? Does creativity and risk tolerance go down as well?
Yeah I am reading through this thread and it does feel that things can go wrong here. With alcohol/drugs it is very likely to be an extremely positive change (at least for the majority), but some people shared videogames, and while they can totally be addicting, I personally place them on the same level as books/shows/movies, and losing interest in all of that is definitely a big change.
Things I have not lost interest for (very much incomplete list): books, food (tho it has changed), my cats, my spouse, my friends, nerdy stuff, etc etc.
I was not addicted to gaming before so can’t really tell the difference there.
I had a lot of fear about this when I resisted getting treated for my very bad Anxiety. I feared that it might change me. I feared that I would be a different person.
Guess what? That's a good thing. The anxious person I was drove me to struggle to do basic life things, struggle to do things I wanted to do, and caused me to drive away someone I loved and harm them.
Fuck that guy, I don't want to be him. I did change. I became able to try new things. I became able to accept other people without needing to impose what I considered "right" onto them. I became able to manage my stupid jealousy to stop it from hurting my relationships.
Now I can ride rollercoasters without having a panic attack. Oh what a shame I lost that guy.
The things that medications treat also cause personality changes. Significant mental or psychological problems consume parts of you, and drive your life negatively.
There's no such thing as a "true" you. You are just biological machines doing chemistry. That chemistry dictates YOU. That chemistry is literally affected by the food you eat. Drawing a line because we require you to get a chemical from someone with a special piece of paper is not reality.
Wearing the proper glasses will cause a personality change if you grew up vision impaired.
Don't deify a broken brain.
Other lies people insist on to avoid medication include "There's no silver bullet/magic pill"
Guess what? Sometimes there is! A low dose of a boring medication fixed my anxiety, as in, turned me from being a dysfunctional anxious wreck to someone who has a normal anxiety response. Even the "side effects" I experience have been positive outcomes.
Now if you do something like take anabolic steroids and it gives you roid rage? Yeah, avoid that, not because "It changed you" but because it made you demonstrably worse in a way you probably do not want
Do you know what else causes irreversible personality changes and will change who you really are?
I think the calorific content of alcohol and general habituation are under-looked. I also basically never drink any more (and am on zep), but when I do occasionally have a craving, an alcohol-free beer 100% hits the spot for me.
I was a light or social drinker for decades. Probably 3-5 drinks per week.
In November of 2024, I decided to avoid alcohol as a personal experiment - no GLP-1 medications involved. I have not consumed any alcohol since.
After 3-4 months, my interest in alcohol seemed to really fall off a cliff. I joked with friends that I was going "dry in 2025", but I am now more seriously considering taking 2026 off from alcohol as well before making a decision about whether to add alcohol back into my diet.
All I will say, is if/when you start noticing digestive issues, it's probably the GLP-1 even if it's after a year of taking the stuff... and woah boy, coming off the stuff is anything but fun.
What was your comedown like? After 6 months of taking subcutaneous semaglutide, I just stopped taking it one day and it was fine. Need a bit more effort to be mindful of snacking now, though.
EDIT: saw your other comment that you felt you were starving. that sucks. the whole thing experience sounds awful.
I have the sulphur burps on Ozempic/Monjourno if I eat too much. I can tell that my digestion has slowed considerably regardless of the affect on my hunger. But the first time it occured terminating the injections terminated the sulphur burps.
Started developing gastroparesis issues after about a year on Trulicity... over the pandemic, due to shortages I was switched to Ozempic for a few months which was less effective with my diabetes mgt. I didn't actually lose weight on the medication(s).
After seeing several doctors about the issue including a couple specialists, only one of about half a dozen medications tried actually worked to help the gastro issues, which included fecal vomiting, rotted fermented food coming up, both regularly. No actual blockages. The medication that did work wasn't covered by my insurance. After a couple years of suffering, I saw a news report about the Trulicity lawsuit related to gastroparesis issues. Over the same period, I started to develop retina issues, several retina bleeds and regular injections to treat it.
When I found out about the lawsuit, I stopped taking the medication going back to straight insulin injections (long and short) currently Lantis and Novalog. For close to a year after coming off, I experienced a feeling of starvation 24/8... didn't matter if I was physically full up to my throat, the ravenous feeling of hunger would not subside. I gained about 80# during this time (again, didn't lose weight on the meds).
I'm a few years off and my digestion is inconsistent and unpredictable... sometimes I'll have a few days where things flow normally... others I'll be backed up for close to a week and have to take a heavy magnesium laxative to get things going again. I stay pretty close to carnivore as just about anything else can range from discomfort to pain. Not to mention legume allergies and really sensitive to wheat... I still cheat about once every other week, and I pay for it physically.
Because I was on more than the one medication, I cannot participate in either the Trulicity or the Ozempic class action lawsuits. These medications have kind of ruined my life. I'm now about half blind and using 45" monitors to work, and even then have to zoom text and lean in to be able to function.
Over the years, I've been on several drugs for diabetes that I'd built up a quick tolerance to, that may have had other negative effects... Byetta, Victoza and others... I've always had digestion sensitivities, these just turned it up to 11. When I started Trulicity, my insulin use was pretty minimal and I was already on a Keto diet and had been losing weight... I wish I'd stuck with that and never even heard of the stuff.
Some of the recollections are a bit jumbled, apologies for that, I'm just kind of writing as it comes to mind.
Aside: along with the medical issues has been some employment inconsistencies the past few years with a few contract roles spread a few months apart. I had hoped to maintain my income level as many available jobs were lower pay. Currently, my insurance is "emergency" coverage based, and doesn't even cover the 3 doctors I'm seeing regularly and doesn't help much with the medications I am still taking. Let alone the eye injections I haven't been able to get for about a year now ($7k/eye/injection). Tried working 2 jobs for a while, but couldn't keep up with the load after a few months. I'm depressed and angry. Prior to about 8 years ago, I never carried debt... now I'm maxed out and staring at bankruptcy.
Just to counter some anecdata here - doing glp-1 for quite some time for weight loss. It works for me for that specific purpose. But I noticed no effect on mood or addictive aspects. But it appears to lower my alcohol tolerance, so I drink less of it. Ymmv
> A more recent RCT showed that low-dose semaglutide reduced laboratory alcohol self-administration, as well as drinks per drinking days and craving, in people with AUD [72].
I think this quote is... wrong? Or at least extremely misleading? Here, citation 72 refers to a paper by Henderson et al. That paper did (sorta) reduced laboratory alcohol self-administration, but did not find any reduction in the amount that people drank. https://dynomight.net/glp-1/
> Semaglutide treatment did not affect average drinks per calendar day or number of drinking days, but significantly reduced drinks per drinking day (β, −0.41; 95% CI, −0.73 to −0.09; P = .04)
So they didn't find any reduction in (1) drinking, or (2) in the number of days that people drank, but they did technically find (3) a reduction in the number of drinks that people consumed on the days that they drank. So I guess what they said is technically correct... but I still think it's very odd not to mention the headline result that there was no actual reduction in drinking!
I don’t understand the math here. The average per calendar day didn’t go down, so the total drinking is the same. That total is distributed among the drinking days, which are also the same. So how can the drinks per drinking day have changed?
1. drinks/day declined in both groups and somewhat more in the treatment group but wasn't statistically significant
2. number of drinks/day basically wasn't different at all
3. drinks/drinking day didn't change in the placebo group but did decline in the treatment group
(These are all actually regression coefficients computed on non-random samples but nevermind.) Somehow it seems like what's happening is that 3 rises to statistical significance even though 1 doesn't.
> a reduction in the number of drinks that people consumed on the days that they drank
I can attest to this myself. I used to be called an "occasional binge drinker" by my endocrinologist. Now I'm just an "occasional drinker". It definitely has cut back my consumption, I'd say by more than half, if not more.
My 24yo is on Mounjaro for type 2 diabetes and has said it’s also eradicated her interest in alcohol. She’s been a typical social drinker but now she’s doing mocktails.
It’d be interesting if these meds help with weight and addiction or just even overdoing it regularly.
It's interesting how many people in the HN comments are on this stuff - here in the UK you can't get it unless your BMI is pretty high. Is it easier to get prescribed in the US or are people just buying the chemicals online?
A side effect of healthcare being a for-profit system in the US means it runs the gamut, from a doctor you meet with in a clinic irl, to a doctor you never actually meet online, you just fill out some digital paperwork for, to the exteme where users get chemicals from sketchy websites and do chemical prep at home. The middle ground is to use an online "pill mill" that ships out from a compounding pharmacy, often not covered by insurance so paid out of pocket. Maybe $300/month? According to online sources aka reddit it's fairly accessible, just fill out an online questionaire and get a prescription from a doctor, followed by getting the medication shipped to you. It was a bit more open during Covid, but it's still relatively accessible. If you do have a high BMI then more mainstream sources are available to you though.
It's estimated that 1.5 million people are taking them in the UK, most of them privately [0].
It's really easy to get them in the UK from a variety of online and high street pharmacies, including from well-known brands like Boots, Lloyds Pharmacy, or ASDA.
I'm not sure how true the stigma is for GLP-1 based drugs. There are lots of online options for getting it from major orgs in the UK including things like Asda who aren't really a well-known pharmacy brand here (https://onlinedoctor.asda.com/uk/weight-loss-treatment.html).
As to advertising, my perception is that it's wrapped in a "weight loss clinic" style presentation but you don't have to be on all the sites long before you get to the "buy $GLP-1" here :)
As a beer enthusiast drinking unhealthy amounts rather too frequently, my drinking went way down when on Mounjaro.
(Maybe it wouldn't have made the same difference if I was into whisky instead of beer - with beer, I suspect it's the relatively large volume of drink involved that may have made it less appealing?)
Recently switched to Wegovy since the big Mounjaro price hikes here in the UK, and it seems rather less effective overall. Both beer and snacks are somewhat more appealing again :(
Side effects are generally rare, but it really depends on the person. I tried to start five times, and got massive side effects each time. The last time I started, I did my own protocol (started at 0.5mg every three days and increased a bit on every injection).
Now I'm up to 6mg and I'm not getting any side effects, but it also doesn't work for me! I lost 6kg at one point but the effects wore off and I gained the weight again.
None of my friends had this experience, for everyone else it's worked with no side effects. I really am cursed.
Be on the look out, I had really bad semaglutide side effects and had to stop. Thought microdosing would help, but the side effects just ramped up more slowly, culminating in what I assume was gastroparesis (my food just stopped digesting for over a day and I couldn’t eat despite being hungry and depleted, not to speak of the rest of the digestive process).
I also had drastically degraded (increased) resting heart rate, (decreased) heart rate variability, and exercise intolerance - a normal easy run started to make it feel like my heart would explode and gave me palpitations. Off it, I can run a 5K and beyond no problem, if my knees cooperate.
Food noise came into the picture much worse than baseline after I stopped, although it did eventually come down and I’ve been able to start losing weight again after a few months off. Berberine seems to help, at the expense of giving me nausea like semaglutide, but no other side effects.
I recall reading a book where a guy used these meds to lose weight. One thing he found was that because he was overeating due to depression, removing his appetite left him a bit stuck because his coping mechanism had been taken away. I would worry that if you're drinking due to an emotional issue, exposing that issue so immediately could have serious consequences if it didn't come with some serious support.
Yeah IIRC the current state of the addiction medicine model is that the drug use of addicts is maladaptive but that there is a real illness or suffering that at one point it gave relief from, or the user thought it would. So someone who gets addicted to opioids after knee surgery is in the same category, doing the same thing, as an alcoholic who started drinking so they wouldn't have nightmares about their abusive childhood. Or whatever. The addict may not always even know explicitly but there is a reason they initially started using in this way.
If you get someone off their normal drug, they a) have none of the other tools or coping mechanisms to deal with the initial problem, having failed to develop them during the years of using drugs instead and b) are grappling with the full and unattenuated experience of whatever caused them to start using in the first place.
People newly detoxed from a long addiction are particularly vulnerable to new addictions and need a lot of support and resolve to develop the intrapersonal emotional skills they've been neglecting. And in some cases picking up a new addiction is the less harmful option. I'm not particularly a fan of AA (but not anti either) but it turns out there was wisdom in their common advice for newly dry alcoholics to not worry about their cigarette or coffee or candy intake. Smoking won't kill you this week but drinking might, you can deal with the nicotine addiction next year.
Which is why GLP-1 are of such interest to some. Anecdotal reports aren't hey, I stopped binge eating but now I'm addicted to gambling, which happens in the world of addiction and addiction treatment. Instead some of the anecdotes are hey I'm not eating as much and I also quit smoking and didn't pick up gambling. Naturally, anecdotes don't prove anything, but there are enough, on this post, even, to warrant further study.
AA is many things. At its heart is a mutually supportive community. For some it works well; it works if you work it. For others, it doesn't. It isn't deep psychotherapy work with a licensed clinician, but the steps do resemble certain pieces of that and lead many to success. The problem is with the numbers, and how success is measured. Someone who's forced into the program, by court order, or by family, and just goes through the motions, counts in the statistics the same as someone that's going of their own volition and is truly committed to their own change.
One of those two people is more likely to succeed in getting dry/clean. The other, less so. It's a shame that both of those people get counted in statistics on AA's efficacy equally.
It's great that it's not replacing one addiction with another. But if, for example, I drink because I had an abusive childhood. Now I can't hide from that via addiction and it's so overwhelming I become deeply depressed and suicidal. So I think for people utilising GLP-1 for an addiction that stems from some particular reason, it might need to be prescribed alongside therapy or something like that.
> Someone who's forced into the program, by court order, or by family
Yeah this is the main problem. AA explicitly requires religious practice, it is only an appropriate approach for people who are already believers or wish to become so.
Not exactly. To adapt with the times, many chapters have adopted a "whatever your higherr power is" attitude. So you do have to have something to refer to, but there's no scripture reading, and it can be things like "other people" or "sunsets" or even "the people running our simulation".
Not all chapters have adopted this, but you can simply not return to a meeting that isn't a good match for you - and there are many reasons, not just religiosity, for a given meeting not being a good match for a given individual.
One thing i noticed being on ozempic at first and then mounjaro after, while mounjaro is better for weight loss in general, ozempic was better at tampering my desire to drink throughout the week (although i wouldn't say i had AUD on either). I think the reason for this is the half life: ozempic is 7 days, (enough to get you until the next once a week dose), while mounjaro is only 5 days (which means by day 6/7 less than half the dose your took at the beginning of the week is still in your system). This also applies to food as well: my craving were less for sweets etc by the end of the week before the next dose on ozempic vs now on mounjaro. Although I think because mounjaro has 2 mechanisms of action vs just 1 for ozempic, I still end up losing more weight. But this is subjective based on my experience.
However, Ozempic will be generic early 2026 in Canada, and there's no way in hell I would pay 4-5x the difference (I'm guessing) for mounjaro as the benefit is relatively minor already given the half life difference (right now the price is almost the same).
I’m not diabetic, so my insurance doesn’t cover it, meaning I have to pay full price, which only went up after Eli Lilly switched from vials to pens in Canada. I genuinely hate Eli Lilly for : 1) their pricing, 2) for eliminating vials in favor of pens, and 3) for how they handled my situation. I reached out to their customer service honestly, admitting I wouldn’t qualify for a discount (even though I’d seen countless Reddit posts from people lying on the form and getting approved anyway and told them this). I reached out and requested in good faith and was flat-out denied, basically brushed off by their support team. This destroyed a lot of goodwill i had initially towards them because of better results and any future brand loyalty I might have had.
So how does this work? Does it somehow boost "willpower" so we can rationally decide which substances we want to consume? Does it somehow smooth out the negative moods that lead us to snack/drink/sleep around/inhale/..? Does it mess with "desire" in general?
On possibility I've seen raised is that slower GI movement -> slower alcohol uptake -> not getting as much of a "hit" from drinking as the effects come on more slowly.
In my personal experience, I do still get the same hit from drinking–I feel a buzz almost immediately, same as before. Rather, I just don't feel the "urge". I've never been a heavy drinker, but I would occasionally crave a beer or two, particularly at the end of a work week. Also, drinking on a GLP1 (I've been on both Tirzepatide and Semaglutide) absolutely wrecks my GI tract for 24-48 hours. Usually with an onset of maybe 8 hours, I get horrible heartburn, moderate to severe nausea, and even mild diarrhea.
I don't think it's any one thing. People like different kinds of alcohol, for different reasons. For someone who's alcohol cravings are based on the sugar in their preferred alcoholic drink, it isn't surprising then, that a medication that lowers their desire to ingest sugar lowers their desire to drink (their chosen sugary drink). Naturally this doesn't cover all alcohol drinkers, but it can't also be none of them.
From my experience, yes, these things as well as making you feel sick and full quicker illicit the same feeling for me as building consistency and routine and grinding it out and a sense of self pride - you know that feeling when you are heading in the right direction and are able to take the harder rather than the easy option deliberately. It's pretty strange that a drug does this and I wonder if coming off them you then find making difficult decisions harder than before because you were faking a muscle normally built through hard work, one of the reasons I decided to stop taking them.
I've noticed that when I'm on Zepbound 2.5mg, I don't have the strong urge to play video games and can focus on my projects. Even if I do play video games while on it, I lose interest after a maximum of half an hour.
I know this is late to this topic, but I was wondering. You say you have more time for your projects, but do you ALSO lose motivation to do your projects too?
I am in a career that I really enjoy, but which requires high motivation and productivity. I don't want to lose that along with the pounds.
Not really. It lets me focus on what I want to focus on without losing motivation. Gaming is just an addictive behavior which is why it works against it, but not real work that I actually want to do.
I'm sorry if it has that effect on you. Personally I've been on tirzepatide for about a year now and have not experienced anything like that.
It seems to reduce my impulsivity, but I still enjoy things very much. I am just able to stop when I "should," or wait for delayed gratification, when previously I had trouble doing so.
I'd say my mood has been higher overall. Feeling like I am in control is an everyday boost.
Maybe this explains why another company just entered into a bidding war with Pfizer to acquire Metsera (MTSR).
Thank God, because my $60 strike call options just turned from a $55k loss to a $180k gain overnight. I shoulda read the CVRs BEFORE buying calls, but I was so blinded by the prospect of easy M&A arbitrage gains I couldn't risk missing out by taking 30 minutes to read the terms of the acquisition.
Glad I have the chance to quit while I'm ahead! Last time I ever fuck around with options trading!
One breakthrough and then a WHOLE BUNCH OF NEW STUFF happens all at once now that this new idea or new pathway is created.
mRNA vaccines break away and now they're testing them in everything. GLP-1 showing signs of use in obesity and now it's being tested for a whole gamut of other things. All very exciting!
I hate these articles so much. The title should be: “Speculation on how GLP-1a drugs could theoretically reduce alcoholism while waiting for any real evidence”.
99% of promising mice studies does not result in clinical practical application in humans. And theoretical associations and mechanisms of action should not be promoted without huge asterisk to contextualize how often such speculation are wrong.
If you complain about AI slop and don’t see how this is just as bad science slop, please go listen to Sabine Hossenfelder. This is just as bad, and create just as much useless noise as AI content does on the nett.
Once-Weekly Semaglutide in Adults With Alcohol Use Disorder
Results
Forty-eight participants (34 [71%] female; mean [SD] age, 39.9 [10.6] years) were randomized. Low-dose semaglutide reduced the amount of alcohol consumed during a posttreatment laboratory self-administration task, with evidence of medium to large effect sizes for grams of alcohol consumed (β, −0.48; 95% CI, −0.85 to −0.11; P = .01) and peak breath alcohol concentration (β, −0.46; 95% CI, −0.87 to −0.06; P = .03). Semaglutide treatment did not affect average drinks per calendar day or number of drinking days, but significantly reduced drinks per drinking day (β, −0.41; 95% CI, −0.73 to −0.09; P = .04) and weekly alcohol craving (β, −0.39; 95% CI, −0.73 to −0.06; P = .01), also predicting greater reductions in heavy drinking over time relative to placebo (β, 0.84; 95% CI, 0.71 to 0.99; P = .04). A significant treatment-by-time interaction indicated that semaglutide treatment predicted greater relative reductions in cigarettes per day in a subsample of individuals with current cigarette use (β, −0.10; 95% CI, −0.16 to −0.03; P = .005).
Much has been said about the GLP drugs and their interactions with all kinds of addictive disorders. Alcohol, drugs, even gambling... Anecdotally, I "struggled" at times with gaming (not joking). I would find myself skipping meetings at times or ducking away to play online sometimes. It never became a real issue but I knew I did it and it was embarrassing.
Once I started on tirzepatide, and then with retatrutide, the "urge" to swap over to my PC between meetings and load up a game is pretty much zeroed out.
Is this an "addiction" or a form of "abuse" similar to alcohol or other drugs? I would have said no some time ago, but now I'm not sure. I definitely feel like, looking back, I was more or less "addicted" to video games. I don't want to romanticize it as some sort of "escape", it just is what it was.
This was an unintended side effect (benefit?) of the drug for sure, in addition to acute weight loss of course.
Unlike many others, even after titrating down and coming off the GLP's, I have not felt the urge to binge food, video games, or anything else. I maintain a healthy, active lifestyle and have kept my weight exactly where I prefer it. My relationship with my body and my time has massively improved. I feel like I am at risk of sounding like a complete shill, obviously, but in my mind these drugs can be something that absolutely has the potential to turn life around for many, many people.
I think it's probably still useful to distinguish addictions with hardcore substance related barriers to quitting (think withdrawals) from addictions where the barrier is a lack of dopamine or serotonin or simple habituation.
For people with normal executive function, the second category of problems should be fairly tractable to overcome, whereas the first is still quite difficult.
The second only really becomes an issue when you have a bit of executive dysfunction.
Maybe that distinction is important and one merits the term addiction while the other doesn't? Though both categories seem to be relatively treatable with drugs that massively improve executive function, so the parallels are pretty glaring.
Most of the addiction literature I've read says that physical addiction is overestimated: even heroin addicts regularly go through physical addiction, either involuntarily because they can't get it, or voluntarily (through treatment efforts, or simply deciding to sober up for e.g. a wedding or other important event). What makes them addicts isn't that they can't stop, it's that they start up again.
Conversely, people hospitalized for something acutely painful often get addicting (or, withdrawal causing) painkillers in amounts and at purities street users can only dream of. And once it's over, they go through withdrawal, and it's deeply unpleasant, and they never want to do it again. People going through something like that aren't more likely to become opioid addicts than anyone else, according to old study results (I may be able to dig them up if you're interested).
It's of course different for chronic pain. But then, the reason for people wanting to start up again is pretty obvious.
> painkillers in amounts and at purities street users can only dream of.
It’s true that pharmaceutical purity is higher, but it’s very much incorrect to say that hospital patients routinely receive higher amounts or doses than street users.
The doses used by chronic opioid, benzo, and stimulant addicts can be absolutely insane compared to even high doses given in medical practice. Even more so after tolerance builds.
This can be a real problem for severe addicts who become hospitalized or end up in the ER because their tolerance is so high that even the high end of doses used in normal patients may do next to nothing in patients with severe addictions.
Addicts also have several factors contributing to the increased severity of their condition: Their route of administration is designed to maximize the ramp up of the dose, which leads to stronger effects, habituation, tolerance, and withdrawal dynamics.
Undergoing many cycles of habituation and withdrawal (missing doses, running out, or just abusing on weekends and trying to stay sober during the week) can actually sensitize addiction problems and exacerbate the problem, even if the doses are not extreme. This is not a problem in a hospital where doses are scheduled and regular.
Finally, the duration of exposure and area under the curve is dramatically different. An addict may be exposed to 100X or 1000X as much of a drug over years due to higher dosing and long term addiction relative to someone in the hospital who undergoes a procedure and then is tapered off.
It’s really misleading to compare opioids or benzos prescribed in a controlled hospital setting to the use by addicts. They are so dramatically different that you can’t compare the addiction and withdrawal dynamics at all.
It's the same compounds, though. And we're only comparing them on one dimension - simple physical addiction. How misleading can it be?
As I said, the studies are old. With the rise of superpotent synthetic opioids in the illegal market, and probably more caution in hospital use - one of the reasons these studies were made, was probably that someone noticed "wow, they sure used a lot of opioids during the Vietnam War, I wonder if that led to a rise in street addicts?" It's possible that it's no longer true that patients get much higher doses than the typical street addict. But it used to be the case, at least, and we can still learn from what we observed back then.
I think there's still plenty of support for the conclusions, that addicts can beat physical addiction, but that they start again, and that the fear of withdrawal pains is not a big factor in what's keeping them as addicts.
Pretty misleading, to be honest. As the parent comment to yours said, the ROA + dose schedule + AUC + peak plasma concentration differ so vastly that "its the same compounds" almost doesn't matter.
The differences between street/illicit use and hospital use are so extreme even just from a physical point of view that it is unreasonable to compare the physical addiction/withdrawal they both cause.
That being said, physical addiction/withdrawal is definitely only one piece of the puzzle of why addiction happens and addicts don't stop their use. I think that using the data of hospitalized patients being able to push through it isn't as strong as an argument for that as you've made it out to be, but that doesn't mean it isn't true.
Addiction is a very hard problem, and I'm hopeful that we'll continue developing new treatments and support methods as a society, even if its semi by accident like with GLP-1s.
I think I have heard the same. People whose lives are hopeless are much more likely to get addicted. The addiction then makes their life worse which causes this downward spiral of despair.
People with physical addictions can choose not to use drugs etc. Smokers can take 12 hour flights and they don't involuntarily take out a lighter and cigarette and smoke half way through. It is about self control.
With my limited second-hand experience, I tend to think it's less about self-control and more about the hopelessness you mentioned earlier - addicts seem to be exactly the people who for various reasons attach very little value to "being a healthy and productive member of society".
> addicts seem to be exactly the people who for various reasons attach very little value to "being a healthy and productive member of society".
These are just the people you notice and see because they don’t care that you see them that way.
My friend worked in the rehab industry. The people who attended rehab came from all different walks of life. Many of them had everything going for them and great lives. It was common for people doing well in work and their social life to think that they could abuse drugs because they could handle it better than “those people” and they wouldn’t allow their use to get out of control.
The idea that addiction is only ever a response to life circumstances is a myth. Lots of people get tangled up with drugs simply because they’re seeking some extra recreational value or euphoria and don’t think the addiction part will apply to them.
In fact, I think the idea that addiction only happens to people who aren’t good members of society is a contributor to many of these people dabbling with drug abuse: They’ve heard so much about addiction only happening to people of poor morale character or who are victims of their circumstances that they think they’re not at risk for addiction because they don’t fit that description.
I agree broadly with everything you've said but I think that you're unnecessarily implying/attempting to isolate it to a single cause, and I think it makes more sense as a variety of causes, all of which can contribute to what creates an addict:
* A lot of people who have broadly good lives get into trouble because their particular blend of biology and mental health makes them vulnerable to addictive behaviors, but others use those same drugs without issues
* People with poor life circumstances (and certain mental health conditions like ADHD) are more susceptible to addiction because they have rough lives and anything that gives you dopamine, be it exercise, casual sex or drugs has the potential to cause addiction, and people in those circumstances utilize behaviors for dopamine release more frequently and readily, and also have a stronger lack of dopamine when they stop
It's a very complex subject that's still developing, but one thing I think we can say for certain is that stigmatizing addicts and addiction and treating the people struggling with it as criminals doesn't solve anything. The criminal penalties for drug use and sale have never once helped anyone. What does seem to reliably help people struggling with addiction, any addiction, is support and safe places/drugs to use. And if GLP-1s can enhance that, I'm all for it.
And, it wouldn't hurt to change our society somewhat so we have fewer people on the bottom rungs of it, barely getting by due to whatever circumstance, whom are then less likely to get in trouble with drugs broadly. And to legalize drugs, because making them illegal doesn't do anything apart from inflate police departments' budgets, and push people who want drugs into dangerous situations, addiction being among them but not the only one.
The distinction you're reaching for is addiction vs dependance.
For clinician, this might be an important distinction. But for a layperson, the distinction is not very clear.
Idk I think the importance given to withdrawals is overrated. Dealing with withdrawals is just matter of gradually lowering the dose.
The lifelong craving is the bigger issue.
How is a lack of dopamine different from "withdrawals"?
“Lack of dopamine” isn’t an accurate description. It’s a reductionist pop culture metaphor that feels scientific but it’s not really accurate. Drugs of abuse involve multiple systems including opioid receptors, which modulate reward. There is much more going on than simple levels of a single neurotransmitter, which can actually be completely normal relative to non-addicts. Dopaminergic systems are actually involved in driving certain addictive and craving mechanisms, which should be a hint that it’s not as simple as “lack of dopamine”.
In fact, the side effects of certain drugs that directly increase dopamine levels (L-DOPA) or drugs that directly stimulate dopamine receptors (dopamine agonists like bromocriptine) include a risk of compulsive gambling, shopping, and risky behaviors.
Ironically it’s more accurate to simply say “withdrawals” than to try to inject reductionist neurotransmitter speak.
What do you now do instead of gaming? Do you find you have swapped for a different activity or a more balanced allocation of time among other things? Or do you still spend your off hours in the same way, but kicked the compulsion for gaming all day?
I do the work I probably should be doing, or side projects, or spend time with my kids, or go on a walk, or follow up on that thing I've been putting off, or any of the other million things that are more productive and fulfilling than video games are. It's embarrassing to admit that I was a grown man who would put off basic, important tasks just to play games but I did. Now I don't.
It's not even really about choosing not to, either... it really does feel fundamentally like I cannot even derive a dopamine response to video games at all anymore, period. Same could probably be said about doom scrolling social media or whatever else. I just get no false positive feedback loop from the act.
If it works for you keep it up. As someone who finds video games an art form I find the 'avoidance to do better things' quite similar to someone who might avoid reading or watching movies as a hobby.
I suppose if you just play the same game day in and day out and it has no real substance (which admittedly is probably the largest gaming segment) it might be a good thing to get rid of the habit. But some games are masterpieces and they often hit very different than other mediums because you are the protagonist making choices. In my opinion some of the best stories come in the form of games and I find it a real shame there's a portion of the population who think they're a complete waste of time.
I think there's also something to be said here about being addicted to work. I know such people and it's just as sad even if it's what society expects of them.
You can't judge someone for not liking a certain hobby. I spend a few hours gaming before bed each night after the bare necessity chores are done, but I have a nagging feeling in the back of my head that there are better things I could be doing with my time, and that's a healthy feeling. I've also had a time in my life where I spent almost all of my awake time trying "artistic" unique indie games, all very highly reviewed and well-made, and while yes, it is a unique and enjoyable art form, it still felt empty in a way. It's still all just pixels on a screen. Yet another Unity game. Yet another fetch side quest. Meanwhile I was unemployed and too depressed to make a good effort at applying for jobs, my self esteem so low that I felt nobody would hire me, living in a crappy old apartment in a crappy part of town, a major downgrade from how my life started.
I don't judge people for it necessarily but I sometimes wonder if they have the wrong idea about what games are. There definitely are problem games that are essentially gambling addictions manifest so the stigma is sometimes warranted. If you sit around playing the same dungeon in a Diablo game 8 hours a day trying to get an item that raises your power 0.5% you're probably off the deep end. But playing something like Clair Obscur or Elden Ring gives me a very unique experience that eventually ends. And the game ending / not wasting your time too much tends to be criteria I use when choosing games as well.
If you look back on that time of low self-esteem and a crappy life I bet there was a myriad of other things causing it and games were just your drug of choice for 'dealing' with it. At least that's my experience. And IMO if your life avoidance drug is games instead of almost anything else (alcohol, marijuana, etc.) you're probably doing better than most in such a situation.
"It's all just pixels on a screen" isn't really an argument for me because my work life, much of my social life, and almost every other form of entertainment that isn't video games (including what I'm doing right now) is all just pixels on a screen as well. And playing games with friends that are across the country or a few hours away is absolutely the best way to be social with them possible. Hell even when I go on vacation I make damn sure I capture pixels on a screen to look at later.
I think the context here is important. regardless if videogames are an artform or not. putting off work, parenting or whatever are priorities in life to get a videogame fix is not the same as playing video games in your leisure time when is not an impulsive decision
That is true, and if something like gaming (or reading, or playing sports, or building model airplanes or whatever other passion) actively interferes with your functional life, that's a huge problem. But there is nothing wrong with taking a day off work to play a new video-game that just came out, if that's your passion, even if it's "putting off work", or similarly in having someone else look after your kids for an evening to enjoy some gaming. Adults very rarely have alloted leisure time where they can just pick an activity. There is always something "more productive" you could be doing instead of pursuing a hobby, especially if you have kids. That doesn't mean that any time you pursue a hobby instead of one of these activities you are being irresponsible - there must be a balance. All work and no play, and all that.
Fully agreed when it starts interfering with your life you should reassess as with anything. But honestly I see gaming as a further place to connect with kids if you enjoy them. Something like Animal Crossing, Mario Kart/Party or Jackbox Party Pack can be some of the best bonding experiences out there. And it also lets you teach your kids how to have a healthy relationship with games/dopamine.
It depends on degrees. If you're going to lose your job and your wife is about to leave you stop doing it. If you just did 12 hours of work/chores/put the kids to bed and want to relax with a bit of gaming? Some people would still feel guilty but I haven't a clue why.
Can't speak for OP but I largely spend it reading (and web). I bought a kindle recently because I found the ipad/iphone were too distracting to reliably avoid web surfing instead of a book. I view the switch to long form content as a form of information dieting in the same way as a switch to whole foods.
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Maybe try NAD+ boosters next? They seem to be reducing addictive behaviors quite a bit. Liposomal NAD+ or nicotinamide riboside or IV NAD+. The theory is an energetic deficit in the brain that drugs/addictions seem to override temporarily but deepen long-term and NAD+ is essentially bringing the energy back. Maybe GLPs do something similar due to flooding the body with broken down fat?
Metabolic dysfunction is the root of many diseases which addiction is one of them .
Do GLPs flood the body with broken down fat? I thought they just suppressed appetite and the like.
People overstate some of the secondary effects, but in a nutshell that’s more or less what they do.
Question: you mentioned that you had weight loss. By chance, know how much LBM (lean body mass) you lost?
Not the person you asked but I have good data - I lost 32kg over 6 months on tirzepatide, 11kg of it was lean body mass, the rest was fat (based on DEXA scans).
In general, lean body mass loss is more of a result of rapid weight loss (I certainly consider mine very rapid), than result of the medication itself. If I was able to lose the same weight in the same period of time without the medication, and kept my protein and resistance training the same, I'd expect a similar ratio of muscle/fat loss.
Overall extremely happy with the outcome, very grateful that these drugs exist and that I was able to access them.
Wow -- That's very rapid weight loss. Congratulations.
68lbs over 9 months for me on Tirzepatide. No exercise (I should, but I'm traveling an absolute ton right so consistent exercise hasn't been prioritized).
> This was an unintended side effect (benefit?) of the drug for sure, in addition to acute weight loss of course.
Is it possible that video games were your escape from a world in which you were obese, with all that it can entail, and losing the weight removed the need to escape?
How do you just start on retatrutide? Did you sign up for a Phase 3 trial?
It’s available in powder form online through “research chemical” sites “not for human consumption”.
Anyone saying they’re taking retatrutide almost certainly obtained it this way. Quality and purity untested.
> Quality and purity untested
Not true for everyone, or perhaps even most playing in this space.
Every batch friends of mine have ordered has been independently tested for purity and dosing. Random batches also tested for sterility.
Plenty of folks yolo it, but it’s not like it was a couple years ago. Lots of group buys being done that order a large batch and then do random sampling for lab testing.
> > Quality and purity untested
> Not true for everyone, or perhaps even most playing in this space.
> Every batch friends of mine have ordered has been independently tested for purity and dosing. Random batches also tested for sterility.
Yes, you have to test it because the quality and purity what you get isn’t tested.
When someone sells something and they make a statement about the product (e.g. “tested”), they don’t mean the customer has to test it.
Not to defend buying research chemicals of unknown safety, but that isnt what he said. Independent labs test for purity and provide certification to the companies that sell them. Those certifications can be verified by anyone. So its much less trust necessary to know what you are getting.
How do you know if the shipment you received was in the same batch that was tested?
Sure, you might be given a "batch number" that matches up with what they said was tested, but that's putting a whole lot of trust in the seller.
Group buy, the organizer tests randomly pulled vials, then ships out the kits to the end customer.
Or you test a vial from your own kit. Expensive but still cheaper than compounded GLP-1.
Or you roll the dice and assume that everything ahipped out about the same time with the same cap color is the same batch.
Or you buy from nexaph.
Everyone has to decide their own comfort zone.
> Independent labs test for purity and provide certification to the companies that sell them.
What's the name of one these independent labs? I would like to read up on them.
As someone else said, Janoshik is popular. But there are others of course. Peptide Test, or Finnrick come to mind.
Janoshik
> Every batch friends of mine have ordered has been independently tested for purity and dosing. Random batches also tested for sterility.
Where are they getting it tested?
3rd party labs with HPLC testing.
Janoshik is a longtime name in this space, originally catering to bodybuilders buying anabolic steroids and HGH.
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You're on Hacker News, you're gonna encounter chemical hacking too, and no shame in that, we're all just chemicals anyways.
It's available at many clearnet peptide websites. Caveat emptor.
Hard to say, you’d need a study.
League of Legends is “used” by a lot of people as medicine. Nobody hides away to play Stanley Parable. Lots of games, lots of genres, difficult to generalize.
I hate to imagine what LOL is used to treat, let alone the side effects.
Deficient cortisol levels, I'd think. I've seen it bring out quite the attitude in otherwise relaxed people.
In our group LoL was regularly used to treat severe sodium deficiencies. Just a few minutes are sufficient to get your sodium up to healthy levels.
same things as drugs and alcohol, I imagine the side effects are different but still negative!
from what I saw people on GPL still eat as much as they can, they just can't eat as much due to the feeling on "fullness" setting in fast. They seem to push the boundaries further the longer they are on it though, so there seems to be some habituation to overcoming the "feeling full".
I guess if you can get addicted to work instead of video games, etc companies will start negotiating with GLP-1 drugmakers directly and make them widely available.
side question - has retatrutide been different enough to tirzepatide for you that you would recommend going to the extra effort to source it?
I think it depends. With tirzepatide (my first encounter with GLP1 meds) I got acute appetite suppression, perhaps too acute. I living comfortably on sometimes 1500 calories or less per day, and I track my calories religiously. We are talking maybe 1 cup of yogurt with frozen berries in the morning, and 1 whey protein shake around 3pm (Fairlife milk + 2 scoops whey) and I would be absolutely full until bed. No energy deficiencies to note. I worked out regularly 5 days a week.
This caused rapid weight loss. A side effect of this rapid weight loss and lack of food intake I also attribute to my thinning hair and dry, splotchy skin outbreaks. Any sort of overeating on tirzepatide (for me) caused severe sickness, or nausea.
Retatrutide, by contrast, causes far less pure appetite suppression (my dosage is also lower) and has another mechanism which helps me maintain leanness while also eating extra calories. I think I prefer the reta, but if I ever felt the need to very simply destroy my appetite again I wouldn't hesitate to use tirzepatide again.
I procured both tirzepatide and retatrutide through the peptide "grey markets" so one was not harder to come by than the other.
I'm considering starting Tirz, but really want to go to retatrutide. Curious if you have a recommendation.
It could also be simply that as you lose weight, you have more tonus (something that I experienced myself), and activities that are inherently passive (watching TV, playing videogame) seem less relatively compeling than more active alternatives.
I'm going to put on my Boomer pull-yourselves-up-by-the-bootstraps hat, but are you concerned about the loss of grit resulting from changing your behaviors without the drug?
Definitely not GP, but I think it’s pretty clear that whatever grit there was to have, GP did not have it. “Die an early death due to being overweight or build the grit” is strictly worse than “lose the weight without building the grit, or build the grit”, and it’s even more so when you realize that “or build the grit” was never in the cards. Because then the choice becomes “die an early death or don’t“. Building the grit can be done on other, hopefully less lethal, projects.
Preface: I'm going to sound quite harsh by changing scales, so put your tough skin on before continuing.
This is certainly worse for the individual, but at society scale, the cost being the obvious devaluation of willpower is way too high. Way too high because everything good in that society was built almost exclusively by driven and strong-willed individuals.
I'll give a reply a go - of course we want strong people. That said, we've introduced incredible amounts of weird new things to the world. Advertising, shit food, tech, and a litany of responsibilities. Some of these are very bad and we all paying heavy prices for it.
I don't think we need to treat every bad thing society does as only needing a "toughen up" solution, instead we should fix the root cause.
An extreme example would be if the government poisons your water, maybe some medicine is ok. We should un-poison the water too, but I'm ok with medicine in the meantime.
Then we should start selecting strong willed individuals who do not fit into the “normie” path as those we uphold and show to be role models and examples.
Instead we collectively shit on them and force them into the most useless lifestyles ever devised - effectively pushing paper on rigid schedules or they don’t get to eat.
I’ve thought about this one quite a bit. The world has narrowed a whole lot to define acceptable behavior and who is allowed a seat at the table.
Almost all those “strong willed” individuals of the past who actually built things had lifestyles that would have gotten them entirely shunned from society today.
It’s not impossible but even compared to 30 years ago it’s an entirely different world for such folks. The way I “came up” in life would not be possible today due to the gatekeepers of “respectable society”.
Needing drugs to fit into that incredibly narrow and basic framework of a life should be of no surprise to anyone. Only a few of incredible luck and willpower and probably even naivety will survive that filter.
This whole topic is the epitome of “show me the incentives and I’ll show you the outcome” - entirely predictable, and it’s what society seems to want.
Expanding on what a sibling comment said, we live in an adversarial environment. A successful food product is one you want to eat, whether you need it or not.
Willpower is important, I agree. Almost everyone needing willpower to not eat, though, is a fairly new phenomenon. If anything, the new drugs restore the balance that existed before —and if willpower is a limited resource, actively help society by returning to us what is taken by the relentless grind of profit maximization.
For a bit. The grind will not sit still.
Willpower to not eat really isn't the same as willpower to eat reasonably (in quantity and quality), though. There's even exercise to offset the effects of suboptimal alimentation.
Either willpower is fungible, in which case it doesn’t matter what you use it on because you’re using it up no matter what, or it isn’t, in which case the original point about losing willpower due to leaning on GPL-1 inhibitors for weight loss is mostly invalid, since it wouldn’t affect the willpower to do other things.
The loss I wrote about is society-wide, not for individuals. Weak-willed people won't change, the problem is the damage to people who have willpower but are basically told it doesn't matter.
It's really a matter of incentives and proper valuation.
Maybe if moral virtues can be purchased they were never moral virtues to begin with?
Many moral vices naturally decline with age as physical senses and hormones dull and life loses novelty. It may be a comforting fantasy that we can somehow link our inevitable physical decline to a story of moral progress and assume that our accumulated wisdom would protect us from the folly of youth if we were somehow thrust again into our younger bodies.
But what if instead moral progress is about finding the right way of living? About spending more time with your kid than with a screen.
Maybe the virtue wasn’t in getting over the wall but finding yourself on the other side and choosing it because it is better? Society puts up walls all the time to prevent people from finding themselves on the wrong side of the wall. Nobody ever talks about the “grit” of the addict persistently dodging law enforcement to score their next fix.
Maybe the problem is society putting walls in the wrong place. If that’s true, does it really matter how you get over the wall?
What do you mean "grit"? Does doing something more efficiently mean you lose it? What's the difference, say, between someone using an LLM to help them code and someone else using a drug to help them diet? Is the coder using an LLM losing their "grit"? Do you walk to work in 30 inches of snow, uphill both ways, in the rain? Are you concerned about your loss of "grit" by not doing so? This argument continues to baffle me.
I didn't take the GLP to help me with addictive behavior traits beyond my diet, but I observed tertiary benefits of the drug.
As I've titrated my dose down to zero, I've retained those habits and my weight. I'm in the best shape of my life and mentally healthier than I've been in over a decade.
I think the comparison to LLM use is a bad idea, because LLM use has pretty clear adverse effects on your capacity to program unassisted, and almost certainly long term limits your potential growth as a programmer, in ways that the LLM can't compensate (at least, not with current tech). Basically using LLMs extensively as a junior may well make you a better junior, but guarantee you'll never be a senior.
My understanding is that that GLP1 drugs don't actually have this effect, as much as we know so far.
Good god no.
If I can change my behaviour and achieve good health outcomes, relatively painlessly, why on earth would I not?
This comes across to me like people who won't use painkillers - I should feel the pain, masking it is fake, there is virtue in suffering etc. Turns out those people often end up with secondary complications to (for example) muscle damage, because they've adapted their movements so much to avoid using the painful muscle that now everything else is tense, strained and locked up.
Better living through chemistry, 100%.
Not the GP, but do you think Serena Williams - world number 1 womens tennis player for 319 weeks, who trained for 5 hours per day at her peak - has insufficient grit?
Because she went on GLP-1 to lose weight.
Grit, or willpower, or whatever you want to name it isn't a unique, constant value. There are plenty of athletes who could spent hours training every day but are overcome by addictions. People who grind at work but cannot fill paperwork to save their life. That will diligently do something for months then stops after an unexpected interruption.
There's probably generally a bit of correlation. But just because someone can be very focused and go to extreme lengths in one aspect of their life doesn't mean they can consistently do it in every aspect of their life.
My last comment was flagged, but the fact remains that Serena Williams is a paid spokesperson for Ro.
https://ro.co/weight-loss/serena/
Her use is an advertisement, it's marketing. Her story as to why she's using it is a fiction, a fabrication.
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Maybe "grit", like phlogiston, isn't real, and neurotransmitters are?
This would be my suspicion as well. Once upon a time, diseases like scurvy, leprosy and cholera were described as caused by insufficient moral fibre of the patient. Maybe this sort of moralizing is the best indicator that the underlying cause of the disease is, in fact, unknown yet.
The current scare mongering over an "increase" in Autism rates is entirely driven by the fact that we stopped diagnosing autistic people as having other intellectual disabilities
Done by the same people who demonstrably treat ADHD as just "laziness"
What if it were possible to get grit from a pill? People who have taken it and come off of it are saying that they haven't reverted. You get good at what you practice, which is as true for grit as it is of anything else. If some people need assistance in getting that practice, this can probably help them. I've taken ritalin for ADHD for a long time, and if I don't take my treatment, I'm still far more focused and productive than I ever was before treatment, because I developed habits through the medication that stuck. I wouldn't be surprised if something similar were at work here.
Turns out that this attitude was bullgrit all along.
I think this is a valid point, and the reason I haven’t tried these drugs and don’t plan to. There are huge benefits to developing the mental strength and discipline to lean into discomfort consistently and just do what needs to be done- and all types of addiction provide one of the hardest, and therefore most valuable and useful obstacles here. As Marcus Aurelius said “The impediment to action advances action. What stands in the way becomes the way.”
I’ve found that the general act of leaning into challenges and mild physical discomfort has a ripple effect on my mind, and all types of addiction and dopamine seeking behaviors become automatically less interesting- almost exactly like what people report on these drugs. If I take a cold shower or work out every morning even when I don’t feel like it- pretty soon I’m eating healthier and limiting my alcohol, caffeine, and screen time without even really trying to.
That said, it only works if you manage to actually do it. It’s much better to get over addiction with a drug than to continue suffering from the addiction, and be unable to escape, especially something that causes as much damage as alcohol can.
One idea I had was to set a deadline for overcoming an addiction, and to just use the drug if you reach the deadline and the mental approach is still unsuccessful.
I wonder if you have more ”grit” than Sugar Ray Leonard, one of the greatest boxers of all time. His fight with Roberto Duran are legendary.
As so many boxers (and many athletes for that matter) he was addicted to drugs and alcohol for many years. Probably sexual abuse he suffered as a kid had something to do with it. He was able to quit, but I think cold shower and a run in the morning was not quite enough to do it.
Nobody just starts abusing their body with chemicals. It is not difficult to quit, you can stay off your Jones for months, but if you do nothing to the demons that made you enter the 36th chamber in the first place, you are going to slip sooner or later. It takes more than a splash of cold water on the face.
Marcus Aurelius was literally a god and the emperor of the world. He prob had little bit more resources to help gim other than stoism. Similarly if you have loving family and friends, a good therapist and some sort of medication,you canmaybe wim the fight with the devil that gets you to use. Training and getting used to being uncomfortable surely helps, but you won’t kick anything for long only with them.
Therefore these drugs won’t be a solution either. Are you going to use them rest of your life? Whatever it is that makes you want to drink, smoke, shoot, gamble or whatever is still going to be there. Bit used together with therapy and loving environment might help. Of course, most addicts have no access to any of these resources.
I agree with all of what you said, and I'd argue that the stoics including Aurelius probably would have as well. Leaning into discomfort is just a step that can help you actually do things like get therapy and be present and engaged in a loving environment. At least for me that's the case- I have seemed to need all of those things together as a system to really thrive in life, not just one or the other.
CBT and ACT are modern therapy methods based on stoic methods, very widely used, and very effective for regular people that aren't emperors.
They are most often effective if you can afford them was my point. I have ADHD as well and boxing (waking up before work to run in cold November morning, 9 rounds with a heavyweight who had nobody his size to spar, thousand ab movements afterwords and hey it’s only Tuesday) helped me tremendously with focus, staying of the booze and so on, but if I had not done years of therapy and had meds as well as found more varing environment, I prob would no be hete. And I was lucky to have a god job to pay for all that.
I do think you need tremendous mental effort, or grit, even to fight serious addiction. But it is only a start.
CBT effectiveness is highly overstated, from anecdotal experience and talking with psychiatrists in a social setting.
It works for a subset of the population that doesn’t question stuff too much and is more or less ok with gaslighting themselves. There is evidence that it loses effectiveness the higher up the IQ scale you go.
The vast majority of mental health issues are a “not treating the root causes” problem. People stuck in a life they despise for various reasons and have no realistic way of changing those root causes. This ranges everywhere from the single mom with 3 kids and an eviction notice all the way to the high powered corporate executive stuck in an empty do-nothing career path.
Not everyone is wired the same but we’ve created a society that you must conform to extremely rigid norms or be at risk of destitution.
If you're wired like Marcus Aurelius, maybe it'll work out ok.
Peoples' neurochemistry differs enormously. One person's positive reinforcing experience is another's nociceptive hell. (source: Ph.D. neurophysiologist here)
Arguments like yours presuppose humans have free will, that it's widely distributed, and if $whoever would just get on it, they'd progress.
More and more, it appears what we have is the perception of free will, not the real thing - whatever that actually might be.
Not doubting your expertise, but I am skeptical of the idea that this method of intentionally leaning into discomfort only works for some minuscule abnormal subset of people that are just wired differently. Instead, I suspect it's tapping into something deeper about how our reward system is structured, something extremely related to how these GLP-1 agonists work, which explains why they are both effective against a shockingly wide array of seemingly different situations.
The basic idea seems to be at the core of both a lot of modern self help gurus advice that seems to actually work for a huge fraction of the people that really commit to them (David Goggins, Wim Hof, etc.) as well as modern psychotherapy systems like CBT and ACT that are proven clinically effective.
How many people are really trying this approach, and it not working for them? More often, I see people saying it sounds like it royally sucks (which is true and basically the entire point), and never trying it- which is valid, but doesn't really demonstrate that it wouldn't work for them.
It absolutely is a "nociceptive hell" at first for everyone that tries it, but when you connect that with intention, purpose, and meaning it eventually transforms into something almost enjoyable. Becoming strong enough to meet discomfort or pain feels amazing, especially for someone that usually experiences the opposite of that.
I also have ADHD, which is explained in part as a developmental disability of executive control, but I find this approach to be extremely effective for regaining executive control, even to levels that people without ADHD lack. Basically, I suspect ADHD isn't a loss of executive control at all, but the executive control is being blocked by something like the feeling of pain or drug withdrawal, and that once you are okay with just having that bad feeling all of the time, you get your executive control back. I'm curious if GLP-1 drugs also help with ADHD? My prediction is that they would.
Nothing they wrote implied minuscule or abnormal.
Can you define huge fraction and really commit? And cite evidence?
I disagree the basic idea of CBT or ACT is leaning into discomfort. In the senses articles suggest David Goggins and Wim Hof advise even less.
CBT and ACT work for many patients and don't work for many patients.
Some people liked intense exercise their whole lives. Some people hated it when they started but liked it eventually. Some people exercised daily since decades and hated every minute. Do you not believe the 1st and 3rd groups?
Pushing through bad feelings is a form of executive control. And ADHD impairments are not limited to impulse control. People who have ADHD who do not take medication have significantly higher rates of driving accidents than people who do not have ADHD or take ADHD medication. Proprioception, internal time perception, and working memory impairments are common.
> I disagree the basic idea of CBT or ACT is leaning into discomfort. In the senses articles suggest David Goggins and Wim Hof advise even less.
I am somewhat baffled by your statement, as I feel it is largely self evident being familiar with, and having tried both therapy methods with professional therapists, and both Goggins and Hof's advice for years. I think a simple wikipedia level explanation of what those things actually are would suffice to answer your question, so I have nothing major to add, unless I am misunderstanding you. Goggins whole shtick in particular is just this one basic point, make yourself as mentally tough as possible by intentionally always doing whatever is difficult. Hof is also just literally getting into very cold water consistently, which is really not easy- and he has no real philosophy or theory, he just has you do it and see what happens.
Perhaps the therapy methods are less clear, but reframing things or deciding on clear values and purpose, are in my view, psychological tools to make the difficult endurable, or in some cases even enjoyable. This makes more sense if you're seeing the methods in the context of how the ancient stoics used the same techniques that inspired those therapies- especially Epictetus.
> Can you define huge fraction and really commit? And cite evidence?
Not really, it's just firsthand experience from doing them, and having widely sought out and read the experiences of others that did online.
In other words, gathering your own anecdote, compounding that with other anecdotes through biased sampling (which kind of person will feel more motivated to share their anecdote on it? And which and anecdotes do you reject because they just didn't try hard enough?) and then projecting that onto every other human being and assuming they must experience the same thing you do.
I never claimed it works for everyone, I am doubting that it is a provable fact that it works for only a minuscule fraction of people- I am not sure exactly what fraction of people this would potentially work for.
You are effectively implying that firsthand experience and expertise are completely worthless, and people can only learn information from large scientific studies, which is nonsense- it would invalidate virtually everything humans know that allows them to effectively navigate the world. I'm a working academic scientist that often designs and executes large studies, and I only ever see these arguments and line of thinking from non-scientists that don't actually understand the limitations of scientific methods, but have turned it into some sort of pseudo-religion.
These are effectively yoga/meditation like techniques that are taught in communities I am part of, and that I have taught to friends and family. I'm not under some delusion that there isn't bias there, I have seen it not work for people, and account for that in my thinking about it. It's been life changing for me, and so I am happy to share info about it in case it might be for others, but I'm not under some delusion that it is the solution to everything.
Correct me if I'm wrong, but I get the impression that your comment isn't really about what I am actually saying, but a general anger towards anything that looks like "pulling yourself up by your own bootstraps"- an anger you can see in other comments in this thread as well. This toxic line of thinking comes from an old fashioned moral argument, that basically derives ones moral standing and worth as a person from the state of being helpless and persecuted, which requires one to actively fight against anything that might be an effective tool to overcome adversity.
I don't agree that using techniques that can help people overcome adversity in any way diminishes the challenges people face, or diminishes things like systematic injustice and addiction that certainly can be due to factors outside of one's control, and hard or impossible to overcome.
Having tools and methods that can, even sometimes, empower people to overcome, survive, and thrive, even if they don't work every time doesn't invalidate those problems, it is just one way to fight them.
“I am skeptical of the idea that this method of intentionally leaning into discomfort only works for some minuscule abnormal subset of people that are just wired differently”
That may be the aspect of this line of thinking that’s not clear then: it doesn’t work for anyone. At least, in so far as the free will is illusory, it is a hallucination that such people have that they made such decisions, and stuck to them. It’s the demon hand syndrome, the person hallucinating a rationale for its motion.
The free will question seems to be a red herring- philosophers and physicists can argue all they want about if something like free will is physically possible or not, but for all intents and purposes, even without free will, the path of someone overcoming, e.g. alcoholism after using these methods requires using them in a way that is challenging, and if you decide on the nihilistic stance that there is no free will so there is no point in ever trying to do anything, then you are guaranteed an undesirable outcome.
Perhaps beforehand it was somehow "pre-determined" which of these attitudes and paths you would take, but that is completely irrelevant for the individual just living life, they have no way to know that one way or another, or any reason to actually care, as they still need to act exactly like they have free will and made the right choice to actually play out a future as the type of person pre-determined to have a desirable outcome.
It doesn't actually feel any easier or less painful to accomplish something difficult, even if free will is some sort of illusion when looked at from the outside perspective. You still experience, e.g. trying and failing over and over and never giving up until you succeed.
I can buy that, for example perhaps there is something outside our control that decides if you are capable of never giving up, but you still cannot know until you decide to never give up and try it- so it literally does not matter except as a philosophical curiosity.
I think a more interesting biological (and philosophical) question is why and how exactly do these GLP-1 drugs work, and why exactly are they so shockingly effective? Maybe they do somehow act on the brain to offer exactly the same psychological benefits as the stoic approach I am talking about, by the same or related underlying mechanism, and they're essentially interchangeable but work more often?
This topic is a great example of how results from down-in-the-weeds biochemistry immediately raise questions at the top levels of consciousness and existence.
“Leaning into discomfort” for personal change may well work for much more than a miniscule fraction of people. It may be that such success is made more likely by some structural predisposition – an attenuated neuronal response to negative reinforcement, or some other precondition that allows its “carrier” to keep plugging to a successful outcome.
But clearly, there’s also a more than miniscule fraction of people for whom that doesn’t work. Their preconditions may deflect them from even trying that particular path, or cause them to give up along the way. I really don’t know, but that fraction seems at least as significant as the fraction for whom uncomfortable personal development paths lead to success.
Early in my career, I strongly believed in free will. I mean, I had it, right? And I didn’t regard my consciousness as all that different from my fellow hominids, so they’re probably all similarly endowed, right? Except...
Over time, research with small molecules like epinephrine and the psychedelics showed that perception/decisions/will could be profoundly influenced by neurochemistry. Ditto for various neuronal illnesses that are associated with profound personality changes.
I regard the GLP-1 results as a further demonstration that “free will”, whatever that is, is fundamentally mechanistic. There are few, maybe no, organismic drives stronger than hunger. A weekly injection of a GLP-1 agonist turns that drive way, way down in most of those who try it. This commonly exhibits itself in profound behavioral modification: if you were an inveterate snacker, suddenly you’re not interested in snacks. You pass them by in your pantry and at the grocery store. Your cognition around snacking changes, to the extent that not only aren’t you snacking, but you might find yourself setting a reminder that it’s time to have lunch. Given the strength of the hunger drive, that’s a very big deal, and revelatory about how we work.
I used to think I understood “free will”. Lately, I find it increasingly hard to define. I’m moving more in the direction of Robert Sapolsky as more research results come in. It feels to me a bit like the “God of the gaps” phenomenon, in which the space available for faith in the supernatural grows smaller with every scientific discovery.
It’s a remarkable time to be alive and have the luxury of considering these questions.
Ah, you might have seen my reply to someone else addressing the free will question from a philosophical angle, but despite also being in the life sciences, I never expected you were thinking about it biochemically.
I think it's obvious that we don't have "free will" in that sense, it had never really occurred to me to consider otherwise- people are definitely quite driven by instincts, neurochemicals, etc. they they can't consciously choose.
However, I think my comment in the other thread still applies- that for an individual, it doesn't really matter one way or another- your firsthand experience is still going to be one of exercising your will to increase the odds of getting outcomes you want in life, or choosing not to, and definitely not getting them.
But there is some biological clue here about who we are, and how our brains work that is fascinating, when you consider the breadth of human health problems and challenges that these GLP-1 agonists influence. I can't wait to see what more is learned about this in the future.
Having "grit" is more likely a symptom of coming from privilege. The marshmallow experiment comes to mind. Some kids were able to resist the urge to not eat the marshmallow for the promise of getting two if they waited. Others could not. The kids that could defer reward ended up having better life outcomes. In retrospect it was a test for privilege. Kids from poorer backgrounds tended to go for the immediate reward of the marshmallow. The test really showed that privileged kids have better life outcomes than kids that don't have privilege. Not really a surprising outcome.
FYI here is the follow on study that controls for socioeconomic factors: https://pmc.ncbi.nlm.nih.gov/articles/PMC6050075/
Anecdotally I've experienced something similar.
After I started committing, really committing to consistently working out, a lot of other things fell into place more or less automatically. I stopped drinking, started eating very cleanly (I became ravenously hungry; junk food and sweets aren't appealing anymore), and stopped spending as much time on gaming. I know your broader point is about leaning into discomfort, but specifically leaning into exercise seems to bring extra benefits. Exercise is medicine, as they say.
I think for this to work psychologically, it just needs to be something difficult or uncomfortable that you can do an awful lot of in a way that is sustainable, and doesn't actively harm you... all the better if you actually benefit directly from it, like with exercising, but cold showers work just as well, simply because they're uncomfortable and take much less time than working out- I personally do both.
The issue with addiction is, it’s very often a symptom of other underlying issues. Relapse are common because too often the underlying problem isn’t treated. Overcoming the addiction is hard because it means facing the thing the addiction allows you to avoid.
Addiction is also common(ism) amongst those who suffer from NDP. In this case, is it truly addiction, or simply another tool in their NPD cache of weapons.
I don’t disagree with you. But it’s also important to be aware of some of the nuances and finer points. I also recommend reading “The Courage to be Disliked”. Not that it / Adler speak to addiction but it’s a thought provoking alternative to the Freudian paradigm.
Getting rid of an addiction also counts as strengthening your mind in itself. A healthier mind will be in a better position to strengthen and fortify itself.
> There are huge benefits to developing the mental strength and discipline to lean into discomfort consistently and just do what needs to be done
Don't fall into 'I can do it, therefore everyone should be able to do it' trap.
Why would you say I am falling into that trap? My comment specifically addressed the issue that it might not work, and included a specific strategy for how to not get stuck too long on the idea of working if it does not.
The idea that some people are overweight simply because they don't have grit, determination and self-discipline is asinine.
If people want to believe in "grit", they at the very least have to also believe in Undset's dictum: the hearts of men do not change, not in any age.
If it's an inherent quality, then there's no reason we should have any less of it than "the greatest generation", or whoever we should want to idolize. The difference has to be external, not internal.
Let's work on what we can change, the external. What you are might change, but you can't change it - that's the core realization behind both European pagan obsession with fate, and Christian obsession with sin.
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You haven't understood what I'm saying. Call it grit, call it character, whatever: it can maybe be developed or change, but not on its own.
Circumstance, including other people, can change it for better or worse, but you can't change it on your own. You are exactly what you are. Without input from outside, you'll never turn into anything that isn't already implicitly there.
To explain it in computer science terms, since this is HN: suppose you have a method which takes no input. Even if it's self-modifying code, can it change into something else? Can it "improve"? No. Whatever it will turn into after overwriting its own code is essentially already there.
You have all the "character", "grit", whatever, that you started off with. If you get some or lose some throughout your life, it's from outside yourself: it can go either way, and you can't take credit for it anyway. This is something that all sorts of pagans, and Christians, have understood for thousands of years, but the modern Horatio Alger "conservative" doesn't understand it.
You appear to be saying that we have no free will because our choices are decided by us and we are the result of our environments. Your self-modifying code argument is that the result is already essentially there from the beginning because that's what the code says to do.
That is not a Christian view as I understand their philosophy. I am not one myself.
I think a better analogy would be self-modifying non-deterministic code. You cannot say in advance what the result will be. The state before execution is not equivalent to the eventual result, because different results are not equivalent to each other and equivalence is transitive. So it can indeed improve. Or get worse.
If the source of that non-determinism (or at least some of it) is our choices then yes of course those choices are constrained or sometimes determined by circumstances or our current past-determined states but that does not mean we do not have the ability to influence our future states.
We have the power to better ourselves even if we don't have the power to directly determine our internal states.
No, free will is really quite beside the point. You can believe the choice is real, whatever you put in that, but the choice will still be based on what you are, and you can't change it, other than based on either 1. what you already are, in which case it isn't really a change, or 2. Something outside of you, input.
Nondeterminism changes nothing for the argument, in fact I mentioned it explicitly already.
You didn't mention it explicitly or otherwise. Why lie? That's such a weird thing to do. I can read your comment and catch you in the lie so easily.
Free will is the entire point. You are saying "the choice will [be] based on what you are, and you can't change it". That is precisely an argument that our choices are determined, not free.
>other than based on either 1. what you already are, in which case it isn't really a change, or 2. Something outside of you, input.
You have just ignored what I said. You cannot say that you haven't changed your character because the change was brought about by your own choice, for the reason I already gave: you have free will, so your choices are not determined, so the results can vary.
You cannot say that A and B are equivalent states because B is reachable from A, when C which is clearly distinct from B is also reachable from A, and the choice between B and C is nondeterministic (free).
To make it more concrete, you have free will. You choose to challenge yourself or not by doing something difficult. That choice is free. It is chosen from among constrained options but it is still a choice. We make constrained choices all the time. They're still choices.
Some people can't afford to buy musical instruments. Of those that can, some choose to buy one and some do not. Of those who do buy one, some choose to practice and some do not. You cannot expect anyone to believe that that choice is free but also that the person that chooses to learn an instrument and practice and develop is identical in character to the same person if they had exercised their choice differently and instead sat on the couch and watched TV.
People make choices. Free choices. Those choices result in the development of their personalities, the development of skills, etc. Those choices are not predetermined by their existing character. There is no external input necessary for your character to change and yet clearly, logically, their character also was not already there. The potential for it may have been there, latently, but so what? Everyone has the potential to have good character. Everyone could be a better person than he is.
_some_ of the overweight people? most certainly! Most of them? I don’t think so.
Life is more complicated than that. We all know that.
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I'm overweight for those reasons.
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Been on Mounjaro/Zepbound for the past 2 years. Lost around 80lbs, and my brain feels like I’m 25 again. Almost no urge for alcohol and have an opened bag of Halloween candy in the closet which isn’t calling my name. But the most surprising part hasn’t been that… it’s that my no limit poker game has gotten really quite good. I’ve played for 20 years, and been well above average, but after the glp-1, something just clicked. Maybe I no longer go on tilt or something? Played in the World Series of poker for the first time last year and placed in the money, in the top 10% after having not played since before Covid. I just started playing in a house game that I’d previously played in 10 years ago. Same people, and before I’d never placed in the money. I’ve now won in 3 of the last 5 games. Something’s different. Is playing poker pleasurable? Not in the least, but a good friend invited me, and played for the social aspect, but now I’m just stunned at how good I’ve suddenly become. Disliked the World Series so much last year, that I opted against playing again, even though I expected to place again. Maybe other poker players will adopt it.
With each HN post GLP-1 drugs sound more and more like a miracle to me. Now it also makes you good in poker? Damn...
I think a lot of drugs are like this though. When concerns and worries are removed, you have more mental capacity for the task at hand.
Small amount of psychoactive substances seem to help a lot of people get into "the zone".
I find it funny there are so many skeptics on HN surrounding GLP-1, but will readily accept the benefits of LSD and micro-dosing.
Just a single datapoint here. About 8 months after starting on semaglutide I took a month off alcohol and by the time the month was over had lost all interest for alcohol.
Almost 2 years now. I'm not religious about it and will occasionally drink the celebratory glass of bubbles or a beer (alcohol free if available) when it's hot outside.
Very interesting how it has worked.
As someone who doesn't really drink and never has alcohol at home, is it just that people buy beer/wine and drink on a daily basis for fun? The wine I feel like you can pair with food and feel classy as an excuse but beer that ain't the case.
I realize how completely dumb this question might sound.
> As someone who doesn't really drink and never has alcohol at home, is it just that people buy beer/wine and drink on a daily basis for fun?
Yes, anything from a couple of drinks a night with dinner / tv to getting blackout drunk multiple times a week, alone, with your significant other, or with friends / roommates.
In the case of people in my social circle (late 30s early 40s) it's primarily still for fun, as well as just a large amount of momentum from your teenage years, 20s, 30s, etc. For a lot of people I know, the association between drinking and good times / relaxation has been deeply engrained since high school.
I've recently taken an extended break for my health, as I'm fully aware that it takes a toll on me, but I still love grabbing some drinks whether I'm relaxing alone in the evening or going out with friends and family.
While it's certainly true that many people get into a dark place with drinking and let it spiral into a self-destructive, depressive pursuit, I don't think it's quite the rule it's made out to be.
I have a good amount of family who live idyllic, full, happy, social lives, drinking heavily multiple times a week with their friends and family into their 70s/80s until death.
Basically I think “a beer would be nice right now” and then I go to the store or local pub.
When drinking small quantities, it's more to relax/unwind at the end of the day than to 'have fun'. Sometimes it's self-medication for stress/depression.
But it can easily escalate into a rather unhealthy habit. And even fairly small amounts can disrupt sleep.
I'm not trying to pick on you because I've seen this anecdote on many occasions; however, it strikes me that people are quite willing to walk past "personality changes" as a side effect of a drug.
Does anyone else feel a slight sense of worry about this?
I don't know much about the drug, maybe you're talking about something else... but FWIW, I got sober from years as a practicing alcoholic the traditional way, I had lots of personality changes, some good some bad, but who I was when I was drinking all day every day and who I am today are quite different people.
I don't think it's a personality change, at least insofar as personality is separate from neurochemistry. Ghrelin and dopamine are strongly linked, and dopamine is our central reward-seeking driver; GLP-1s generally reduce ghrelin production, which I suspect helps remove you from a state of being constantly primed for reward-seeking. I noticed this firsthand when I went hard keto for the first time, and could suddently for the first time tell a significant difference between "I want food because I'm hungry" and "I'm not hungry but want food because it's pleasurable".
Worry about a positive side effect? No.
I worry about it. I do tend to wonder if it can change your relationship with addictive and maybe risky behaviors, does it also potentially make you into a more conservative (not politically) person? Does creativity and risk tolerance go down as well?
Yeah I am reading through this thread and it does feel that things can go wrong here. With alcohol/drugs it is very likely to be an extremely positive change (at least for the majority), but some people shared videogames, and while they can totally be addicting, I personally place them on the same level as books/shows/movies, and losing interest in all of that is definitely a big change.
Things I have not lost interest for (very much incomplete list): books, food (tho it has changed), my cats, my spouse, my friends, nerdy stuff, etc etc.
I was not addicted to gaming before so can’t really tell the difference there.
It has definitely come up in books and podcasts I’ve listened to, but given general cultural values and biases I don’t think it gets much traction.
I had a lot of fear about this when I resisted getting treated for my very bad Anxiety. I feared that it might change me. I feared that I would be a different person.
Guess what? That's a good thing. The anxious person I was drove me to struggle to do basic life things, struggle to do things I wanted to do, and caused me to drive away someone I loved and harm them.
Fuck that guy, I don't want to be him. I did change. I became able to try new things. I became able to accept other people without needing to impose what I considered "right" onto them. I became able to manage my stupid jealousy to stop it from hurting my relationships.
Now I can ride rollercoasters without having a panic attack. Oh what a shame I lost that guy.
The things that medications treat also cause personality changes. Significant mental or psychological problems consume parts of you, and drive your life negatively.
There's no such thing as a "true" you. You are just biological machines doing chemistry. That chemistry dictates YOU. That chemistry is literally affected by the food you eat. Drawing a line because we require you to get a chemical from someone with a special piece of paper is not reality.
Wearing the proper glasses will cause a personality change if you grew up vision impaired.
Don't deify a broken brain.
Other lies people insist on to avoid medication include "There's no silver bullet/magic pill"
Guess what? Sometimes there is! A low dose of a boring medication fixed my anxiety, as in, turned me from being a dysfunctional anxious wreck to someone who has a normal anxiety response. Even the "side effects" I experience have been positive outcomes.
Now if you do something like take anabolic steroids and it gives you roid rage? Yeah, avoid that, not because "It changed you" but because it made you demonstrably worse in a way you probably do not want
Do you know what else causes irreversible personality changes and will change who you really are?
Aging.
I think the calorific content of alcohol and general habituation are under-looked. I also basically never drink any more (and am on zep), but when I do occasionally have a craving, an alcohol-free beer 100% hits the spot for me.
I was a light or social drinker for decades. Probably 3-5 drinks per week.
In November of 2024, I decided to avoid alcohol as a personal experiment - no GLP-1 medications involved. I have not consumed any alcohol since.
After 3-4 months, my interest in alcohol seemed to really fall off a cliff. I joked with friends that I was going "dry in 2025", but I am now more seriously considering taking 2026 off from alcohol as well before making a decision about whether to add alcohol back into my diet.
All I will say, is if/when you start noticing digestive issues, it's probably the GLP-1 even if it's after a year of taking the stuff... and woah boy, coming off the stuff is anything but fun.
What was your comedown like? After 6 months of taking subcutaneous semaglutide, I just stopped taking it one day and it was fine. Need a bit more effort to be mindful of snacking now, though.
EDIT: saw your other comment that you felt you were starving. that sucks. the whole thing experience sounds awful.
I have the sulphur burps on Ozempic/Monjourno if I eat too much. I can tell that my digestion has slowed considerably regardless of the affect on my hunger. But the first time it occured terminating the injections terminated the sulphur burps.
How so? Can you describe more of your experience if you don't mind sharing?
Started developing gastroparesis issues after about a year on Trulicity... over the pandemic, due to shortages I was switched to Ozempic for a few months which was less effective with my diabetes mgt. I didn't actually lose weight on the medication(s).
After seeing several doctors about the issue including a couple specialists, only one of about half a dozen medications tried actually worked to help the gastro issues, which included fecal vomiting, rotted fermented food coming up, both regularly. No actual blockages. The medication that did work wasn't covered by my insurance. After a couple years of suffering, I saw a news report about the Trulicity lawsuit related to gastroparesis issues. Over the same period, I started to develop retina issues, several retina bleeds and regular injections to treat it.
When I found out about the lawsuit, I stopped taking the medication going back to straight insulin injections (long and short) currently Lantis and Novalog. For close to a year after coming off, I experienced a feeling of starvation 24/8... didn't matter if I was physically full up to my throat, the ravenous feeling of hunger would not subside. I gained about 80# during this time (again, didn't lose weight on the meds).
I'm a few years off and my digestion is inconsistent and unpredictable... sometimes I'll have a few days where things flow normally... others I'll be backed up for close to a week and have to take a heavy magnesium laxative to get things going again. I stay pretty close to carnivore as just about anything else can range from discomfort to pain. Not to mention legume allergies and really sensitive to wheat... I still cheat about once every other week, and I pay for it physically.
Because I was on more than the one medication, I cannot participate in either the Trulicity or the Ozempic class action lawsuits. These medications have kind of ruined my life. I'm now about half blind and using 45" monitors to work, and even then have to zoom text and lean in to be able to function.
Over the years, I've been on several drugs for diabetes that I'd built up a quick tolerance to, that may have had other negative effects... Byetta, Victoza and others... I've always had digestion sensitivities, these just turned it up to 11. When I started Trulicity, my insulin use was pretty minimal and I was already on a Keto diet and had been losing weight... I wish I'd stuck with that and never even heard of the stuff.
Some of the recollections are a bit jumbled, apologies for that, I'm just kind of writing as it comes to mind.
Aside: along with the medical issues has been some employment inconsistencies the past few years with a few contract roles spread a few months apart. I had hoped to maintain my income level as many available jobs were lower pay. Currently, my insurance is "emergency" coverage based, and doesn't even cover the 3 doctors I'm seeing regularly and doesn't help much with the medications I am still taking. Let alone the eye injections I haven't been able to get for about a year now ($7k/eye/injection). Tried working 2 jobs for a while, but couldn't keep up with the load after a few months. I'm depressed and angry. Prior to about 8 years ago, I never carried debt... now I'm maxed out and staring at bankruptcy.
That sounds pretty awful. Hang in there. Hope you have a support network of sorts and find a way out.
Just to counter some anecdata here - doing glp-1 for quite some time for weight loss. It works for me for that specific purpose. But I noticed no effect on mood or addictive aspects. But it appears to lower my alcohol tolerance, so I drink less of it. Ymmv
> A more recent RCT showed that low-dose semaglutide reduced laboratory alcohol self-administration, as well as drinks per drinking days and craving, in people with AUD [72].
I think this quote is... wrong? Or at least extremely misleading? Here, citation 72 refers to a paper by Henderson et al. That paper did (sorta) reduced laboratory alcohol self-administration, but did not find any reduction in the amount that people drank. https://dynomight.net/glp-1/
OK looking at the original abstract:
> Semaglutide treatment did not affect average drinks per calendar day or number of drinking days, but significantly reduced drinks per drinking day (β, −0.41; 95% CI, −0.73 to −0.09; P = .04)
So they didn't find any reduction in (1) drinking, or (2) in the number of days that people drank, but they did technically find (3) a reduction in the number of drinks that people consumed on the days that they drank. So I guess what they said is technically correct... but I still think it's very odd not to mention the headline result that there was no actual reduction in drinking!
I don’t understand the math here. The average per calendar day didn’t go down, so the total drinking is the same. That total is distributed among the drinking days, which are also the same. So how can the drinks per drinking day have changed?
Strange, right? Take a look at figure 4 here: https://jamanetwork.com/journals/jamapsychiatry/fullarticle/...
This is as in the abstract:
1. drinks/day declined in both groups and somewhat more in the treatment group but wasn't statistically significant 2. number of drinks/day basically wasn't different at all 3. drinks/drinking day didn't change in the placebo group but did decline in the treatment group
(These are all actually regression coefficients computed on non-random samples but nevermind.) Somehow it seems like what's happening is that 3 rises to statistical significance even though 1 doesn't.
> a reduction in the number of drinks that people consumed on the days that they drank
I can attest to this myself. I used to be called an "occasional binge drinker" by my endocrinologist. Now I'm just an "occasional drinker". It definitely has cut back my consumption, I'd say by more than half, if not more.
My 24yo is on Mounjaro for type 2 diabetes and has said it’s also eradicated her interest in alcohol. She’s been a typical social drinker but now she’s doing mocktails.
It’d be interesting if these meds help with weight and addiction or just even overdoing it regularly.
It's interesting how many people in the HN comments are on this stuff - here in the UK you can't get it unless your BMI is pretty high. Is it easier to get prescribed in the US or are people just buying the chemicals online?
A side effect of healthcare being a for-profit system in the US means it runs the gamut, from a doctor you meet with in a clinic irl, to a doctor you never actually meet online, you just fill out some digital paperwork for, to the exteme where users get chemicals from sketchy websites and do chemical prep at home. The middle ground is to use an online "pill mill" that ships out from a compounding pharmacy, often not covered by insurance so paid out of pocket. Maybe $300/month? According to online sources aka reddit it's fairly accessible, just fill out an online questionaire and get a prescription from a doctor, followed by getting the medication shipped to you. It was a bit more open during Covid, but it's still relatively accessible. If you do have a high BMI then more mainstream sources are available to you though.
It's estimated that 1.5 million people are taking them in the UK, most of them privately [0].
It's really easy to get them in the UK from a variety of online and high street pharmacies, including from well-known brands like Boots, Lloyds Pharmacy, or ASDA.
[0] - https://www.bbc.co.uk/news/articles/c981044pgvyo
You only need a BMI of 30 to get a private subscription. That's a pretty large portion of the population (no pun intended).
Note that you can't advertise prescription drugs in the UK. There's also still a bit of a stigma about going private, and it's expensive.
I'm not sure how true the stigma is for GLP-1 based drugs. There are lots of online options for getting it from major orgs in the UK including things like Asda who aren't really a well-known pharmacy brand here (https://onlinedoctor.asda.com/uk/weight-loss-treatment.html).
As to advertising, my perception is that it's wrapped in a "weight loss clinic" style presentation but you don't have to be on all the sites long before you get to the "buy $GLP-1" here :)
As an alcohol enthusiast on 12.5mg of Zepbound for the last several months, my ethanol consumption hasn’t diminished much
As a beer enthusiast drinking unhealthy amounts rather too frequently, my drinking went way down when on Mounjaro.
(Maybe it wouldn't have made the same difference if I was into whisky instead of beer - with beer, I suspect it's the relatively large volume of drink involved that may have made it less appealing?)
Recently switched to Wegovy since the big Mounjaro price hikes here in the UK, and it seems rather less effective overall. Both beer and snacks are somewhat more appealing again :(
Interesting that Moujourno helped more than other brands. Might give that a try ;)
Mounjaro and Zepbound are chemically identical. Both are tirzepatide, just labeled for different use-cases. (Diabetes vs. weight loss)
Wegovy/Ozempic are semaglutide.
Interesting. I'm at zepbound 5mg and noticed that alcohol brings me no joy.
It used to be the case that 1-2 drinks would make me feel good, and introduce a craving for more (a "just one more will get me right" feeling).
But that's gone now. It's an amazing side effect.
I can also add I have little to zero side effects from Zepboubd if that adds anything
Side effects are generally rare, but it really depends on the person. I tried to start five times, and got massive side effects each time. The last time I started, I did my own protocol (started at 0.5mg every three days and increased a bit on every injection).
Now I'm up to 6mg and I'm not getting any side effects, but it also doesn't work for me! I lost 6kg at one point but the effects wore off and I gained the weight again.
None of my friends had this experience, for everyone else it's worked with no side effects. I really am cursed.
Be on the look out, I had really bad semaglutide side effects and had to stop. Thought microdosing would help, but the side effects just ramped up more slowly, culminating in what I assume was gastroparesis (my food just stopped digesting for over a day and I couldn’t eat despite being hungry and depleted, not to speak of the rest of the digestive process).
I also had drastically degraded (increased) resting heart rate, (decreased) heart rate variability, and exercise intolerance - a normal easy run started to make it feel like my heart would explode and gave me palpitations. Off it, I can run a 5K and beyond no problem, if my knees cooperate.
Food noise came into the picture much worse than baseline after I stopped, although it did eventually come down and I’ve been able to start losing weight again after a few months off. Berberine seems to help, at the expense of giving me nausea like semaglutide, but no other side effects.
have you lost weight?
Yup, 20lbs effortlessly. But I’ve plateaued despite going up in dosage. So still stuck at 200lbs
20lbs is still a fantastic achievement!
Is there any anecdata about emotional well-being for people without any conditions these medications are usually prescribed?
I recall reading a book where a guy used these meds to lose weight. One thing he found was that because he was overeating due to depression, removing his appetite left him a bit stuck because his coping mechanism had been taken away. I would worry that if you're drinking due to an emotional issue, exposing that issue so immediately could have serious consequences if it didn't come with some serious support.
Yeah IIRC the current state of the addiction medicine model is that the drug use of addicts is maladaptive but that there is a real illness or suffering that at one point it gave relief from, or the user thought it would. So someone who gets addicted to opioids after knee surgery is in the same category, doing the same thing, as an alcoholic who started drinking so they wouldn't have nightmares about their abusive childhood. Or whatever. The addict may not always even know explicitly but there is a reason they initially started using in this way.
If you get someone off their normal drug, they a) have none of the other tools or coping mechanisms to deal with the initial problem, having failed to develop them during the years of using drugs instead and b) are grappling with the full and unattenuated experience of whatever caused them to start using in the first place.
People newly detoxed from a long addiction are particularly vulnerable to new addictions and need a lot of support and resolve to develop the intrapersonal emotional skills they've been neglecting. And in some cases picking up a new addiction is the less harmful option. I'm not particularly a fan of AA (but not anti either) but it turns out there was wisdom in their common advice for newly dry alcoholics to not worry about their cigarette or coffee or candy intake. Smoking won't kill you this week but drinking might, you can deal with the nicotine addiction next year.
Which is why GLP-1 are of such interest to some. Anecdotal reports aren't hey, I stopped binge eating but now I'm addicted to gambling, which happens in the world of addiction and addiction treatment. Instead some of the anecdotes are hey I'm not eating as much and I also quit smoking and didn't pick up gambling. Naturally, anecdotes don't prove anything, but there are enough, on this post, even, to warrant further study.
AA is many things. At its heart is a mutually supportive community. For some it works well; it works if you work it. For others, it doesn't. It isn't deep psychotherapy work with a licensed clinician, but the steps do resemble certain pieces of that and lead many to success. The problem is with the numbers, and how success is measured. Someone who's forced into the program, by court order, or by family, and just goes through the motions, counts in the statistics the same as someone that's going of their own volition and is truly committed to their own change.
One of those two people is more likely to succeed in getting dry/clean. The other, less so. It's a shame that both of those people get counted in statistics on AA's efficacy equally.
It's great that it's not replacing one addiction with another. But if, for example, I drink because I had an abusive childhood. Now I can't hide from that via addiction and it's so overwhelming I become deeply depressed and suicidal. So I think for people utilising GLP-1 for an addiction that stems from some particular reason, it might need to be prescribed alongside therapy or something like that.
> Someone who's forced into the program, by court order, or by family
Yeah this is the main problem. AA explicitly requires religious practice, it is only an appropriate approach for people who are already believers or wish to become so.
Not exactly. To adapt with the times, many chapters have adopted a "whatever your higherr power is" attitude. So you do have to have something to refer to, but there's no scripture reading, and it can be things like "other people" or "sunsets" or even "the people running our simulation".
Not all chapters have adopted this, but you can simply not return to a meeting that isn't a good match for you - and there are many reasons, not just religiosity, for a given meeting not being a good match for a given individual.
One thing i noticed being on ozempic at first and then mounjaro after, while mounjaro is better for weight loss in general, ozempic was better at tampering my desire to drink throughout the week (although i wouldn't say i had AUD on either). I think the reason for this is the half life: ozempic is 7 days, (enough to get you until the next once a week dose), while mounjaro is only 5 days (which means by day 6/7 less than half the dose your took at the beginning of the week is still in your system). This also applies to food as well: my craving were less for sweets etc by the end of the week before the next dose on ozempic vs now on mounjaro. Although I think because mounjaro has 2 mechanisms of action vs just 1 for ozempic, I still end up losing more weight. But this is subjective based on my experience.
However, Ozempic will be generic early 2026 in Canada, and there's no way in hell I would pay 4-5x the difference (I'm guessing) for mounjaro as the benefit is relatively minor already given the half life difference (right now the price is almost the same).
I’m not diabetic, so my insurance doesn’t cover it, meaning I have to pay full price, which only went up after Eli Lilly switched from vials to pens in Canada. I genuinely hate Eli Lilly for : 1) their pricing, 2) for eliminating vials in favor of pens, and 3) for how they handled my situation. I reached out to their customer service honestly, admitting I wouldn’t qualify for a discount (even though I’d seen countless Reddit posts from people lying on the form and getting approved anyway and told them this). I reached out and requested in good faith and was flat-out denied, basically brushed off by their support team. This destroyed a lot of goodwill i had initially towards them because of better results and any future brand loyalty I might have had.
buy a share of LLY every time you buy a pen, you'll be selling the stuff to yourself soon.
i doubt it would help, their stock will probably go down as glp lose their patents globally in most countries and become generics
So how does this work? Does it somehow boost "willpower" so we can rationally decide which substances we want to consume? Does it somehow smooth out the negative moods that lead us to snack/drink/sleep around/inhale/..? Does it mess with "desire" in general?
On possibility I've seen raised is that slower GI movement -> slower alcohol uptake -> not getting as much of a "hit" from drinking as the effects come on more slowly.
In my personal experience, I do still get the same hit from drinking–I feel a buzz almost immediately, same as before. Rather, I just don't feel the "urge". I've never been a heavy drinker, but I would occasionally crave a beer or two, particularly at the end of a work week. Also, drinking on a GLP1 (I've been on both Tirzepatide and Semaglutide) absolutely wrecks my GI tract for 24-48 hours. Usually with an onset of maybe 8 hours, I get horrible heartburn, moderate to severe nausea, and even mild diarrhea.
I don't think it's any one thing. People like different kinds of alcohol, for different reasons. For someone who's alcohol cravings are based on the sugar in their preferred alcoholic drink, it isn't surprising then, that a medication that lowers their desire to ingest sugar lowers their desire to drink (their chosen sugary drink). Naturally this doesn't cover all alcohol drinkers, but it can't also be none of them.
My understanding is it essentially tamps down cravings.
From my experience, yes, these things as well as making you feel sick and full quicker illicit the same feeling for me as building consistency and routine and grinding it out and a sense of self pride - you know that feeling when you are heading in the right direction and are able to take the harder rather than the easy option deliberately. It's pretty strange that a drug does this and I wonder if coming off them you then find making difficult decisions harder than before because you were faking a muscle normally built through hard work, one of the reasons I decided to stop taking them.
I've noticed that when I'm on Zepbound 2.5mg, I don't have the strong urge to play video games and can focus on my projects. Even if I do play video games while on it, I lose interest after a maximum of half an hour.
I know this is late to this topic, but I was wondering. You say you have more time for your projects, but do you ALSO lose motivation to do your projects too?
I am in a career that I really enjoy, but which requires high motivation and productivity. I don't want to lose that along with the pounds.
Not really. It lets me focus on what I want to focus on without losing motivation. Gaming is just an addictive behavior which is why it works against it, but not real work that I actually want to do.
What if work is the addiction? Or Solving Puzzles?
Does GPL-1 also dampen those? How much does it dampen just any fixed behavior?
GLP1s seem like the closest thing we’ve had to miracle drugs in years if not decades.
It also affects mood - basically removing desire for anything.
I'm sorry if it has that effect on you. Personally I've been on tirzepatide for about a year now and have not experienced anything like that.
It seems to reduce my impulsivity, but I still enjoy things very much. I am just able to stop when I "should," or wait for delayed gratification, when previously I had trouble doing so.
I'd say my mood has been higher overall. Feeling like I am in control is an everyday boost.
is this anecdotal?
Why would a GLP-1 be used to dampen reward over an anti-psychotic?
https://pmc.ncbi.nlm.nih.gov/articles/PMC8820218/
It seems it doesn't block dopamine generally, but does seem to act on dopamine spikes?
Maybe this explains why another company just entered into a bidding war with Pfizer to acquire Metsera (MTSR).
Thank God, because my $60 strike call options just turned from a $55k loss to a $180k gain overnight. I shoulda read the CVRs BEFORE buying calls, but I was so blinded by the prospect of easy M&A arbitrage gains I couldn't risk missing out by taking 30 minutes to read the terms of the acquisition.
Glad I have the chance to quit while I'm ahead! Last time I ever fuck around with options trading!
Technology and discovery are so cool.
One breakthrough and then a WHOLE BUNCH OF NEW STUFF happens all at once now that this new idea or new pathway is created.
mRNA vaccines break away and now they're testing them in everything. GLP-1 showing signs of use in obesity and now it's being tested for a whole gamut of other things. All very exciting!
This was the framing behind James Burke's Connections if I recall, a wonderful documentary series.
I hate these articles so much. The title should be: “Speculation on how GLP-1a drugs could theoretically reduce alcoholism while waiting for any real evidence”.
99% of promising mice studies does not result in clinical practical application in humans. And theoretical associations and mechanisms of action should not be promoted without huge asterisk to contextualize how often such speculation are wrong.
If you complain about AI slop and don’t see how this is just as bad science slop, please go listen to Sabine Hossenfelder. This is just as bad, and create just as much useless noise as AI content does on the nett.
https://jamanetwork.com/journals/jamapsychiatry/fullarticle/...
Once-Weekly Semaglutide in Adults With Alcohol Use Disorder
Results
Forty-eight participants (34 [71%] female; mean [SD] age, 39.9 [10.6] years) were randomized. Low-dose semaglutide reduced the amount of alcohol consumed during a posttreatment laboratory self-administration task, with evidence of medium to large effect sizes for grams of alcohol consumed (β, −0.48; 95% CI, −0.85 to −0.11; P = .01) and peak breath alcohol concentration (β, −0.46; 95% CI, −0.87 to −0.06; P = .03). Semaglutide treatment did not affect average drinks per calendar day or number of drinking days, but significantly reduced drinks per drinking day (β, −0.41; 95% CI, −0.73 to −0.09; P = .04) and weekly alcohol craving (β, −0.39; 95% CI, −0.73 to −0.06; P = .01), also predicting greater reductions in heavy drinking over time relative to placebo (β, 0.84; 95% CI, 0.71 to 0.99; P = .04). A significant treatment-by-time interaction indicated that semaglutide treatment predicted greater relative reductions in cigarettes per day in a subsample of individuals with current cigarette use (β, −0.10; 95% CI, −0.16 to −0.03; P = .005).
We've finally invented Soma. Perhaps finally something the Republicans can agree to fund Medicare for?