This morning’s Metro newspaper has a double-page spread on The Fix:

How many times have you checked your phone for messages so far today? Do you constantly have one eye on your Twitter mentions feed to see who’s talking about you? Would you like another cupcake?

If your answers to these three questions are ’32’, ‘Both eyes’ and ‘No thank-you, a fourth would be too much for me’, then there is nothing special about you whatsoever.

You are just one of the millions who find themselves compelled to continuously refresh their emails and help themselves to just one more piece of cake.

In his latest book, The Fix, which has the slightly frightening subtitle, ‘How addiction is invading our lives and taking over your world,’ Damian Thompson, blogs editor at The Telegraph, says that it is becoming harder and harder for all of us to resist the world’s temptations.

For Mr Thompson, one example of this is how sweet bakery goods have become culinary cocaine – ‘Why cake is the new coke’ is the title of one of the book’s chapters.

‘If you see people bring cake or donuts into an office, people flock to it and then make return visits,’ he told Metro.

‘It does remind me of hedge fund managers or city businessmen in the 1980s frantically returning to the glass table on which the lines of coke are set out.

‘The little sugar buzz is so intense and so irresistible that a little drama of temptation is played out in the office.’

The Fix examines how cupcakes, prescription drugs, smartphones, internet gaming and online pornography are becoming our new addictions of choice.

Mr Thompson speaks from experience. A former alcoholic, he has been sober for 18 years, thanks in part to the help of Alcoholics Anonymous (AA).

He has been criticised in some quarters for his insistence in the book that addiction isn’t a disease, something that flies in the face of what many alcoholics adhere to when going through AA.

‘My own experience of AA was very, very helpful,’ he recalled. ‘I was almost the caricature of a drunken, young journalist. I reached a point where if I kept on drinking it was clearly going to kill me…’

You can read the rest here.

Extracts from today’s five-star review of The Fix by Britain’s Education Secretary in The Mail on Sunday

…. for the most edgy of today’s writers, the battle zones they want to explore are not foreign fields but their own bodies.

Whether it’s been Irvine Welsh’s exploration of the effect of heroin on a young Edinburgh hedonist, Bill Clegg’s chronicle of a gilded American yuppie’s descent into drug abuse, James Frey’s invented memoir A Million Little Pieces or, most impressive of all, Edward St Aubyn’s Patrick Melrose novels, addiction has become the new enemy with which the bravest of our youth dare to do battle.

Damian Thompson, too, has visited the most dangerous parts of that battlefield. And in this wonderfully honest, perceptive book he makes clear that addiction, like war, is Hell.

He spares us nothing from his own experience as an alcoholic and prescription-drug abuser. He is not inviting us to admire his outré bohemian past or his attempt to reach the palace of wisdom via the road-of-excess Rioja. He is painfully honest about the sadness – in both senses of the word – of working your way through bottles of red wine on your own, waking up not knowing in whose house you’ve been incubating a hangover, and then looking forward to the buzz later from a special sleeping pill.

Thompson’s skill as a reporter, and moral courage as a man, is on display throughout this book in his pitiless account of his own weakness. But even more impressive than this is his insightful analysis. Having reflected so honestly and unsparingly on his own addiction, he is in a strong position to see how addiction is warping society.

He knows that many of those offering help to addicts are also selling an ideology. He sees through the 12-steps theology of Alcoholics Anonymous, which regards addiction as a disease, thus robbing the individual of free will and control over their own lives. Thompson shows brilliantly that indulgence in intoxicants – whether Vietnamese heroin or Hogarth’s gin – has as much to do with the mores of your peer-group as it does with any in-built condition or ‘disease’ of the mind. But, more importantly, he also sees through the little lies we all tell ourselves about our tastes and habits, and discerns the patterns of addictive behaviour beneath …

Thompson shows how the upsurge in recreational use of prescription drugs, easier access to pornography, the ubiquity and sophistication of computer games and even the substitution of sugar-rich muffins (really a massive lump of cake) for a slice of toast at breakfast are all feeding guilty appetites …

Thompson’s book is at once blackly funny, intellectually serious and compellingly readable, but it does not make many recommendations as to what steps we might take to reverse these unhappy trends.

He knows that if the addict is to recover, the first step is to acknowledge the scale of the problem. It is for each of us to take responsibility for our own recovery.

The backlash against sugar – based on growing recognition of its addictive properties – is gathering pace. Here’s this week’s Guardian broadside against the white stuff. And here’s one of my favourite bloggers, Francis Phillips of the Catholic Herald, laying down the law:

Boris Johnson wrote an interesting article in the Telegraph on Monday, all about the Mayor of New York’s attempt to curb some of the worst excesses of his fat citizenry’s diet viz a ban on super-sized cups of sugary drinks like soda. It is hardly necessary to explain why; as Damian Thompson points out in his new book, The Fix; How addiction is invading our lives and taking over your world (I’m hoping that my mention of it here will get me a free review copy) [yes it will - Ed], sugar is in almost everything we eat and drink and it is slowly killing us.

Our attitude to sugar needs to go the same way as smoking. Looking back on the anti-smoking campaign it seems extraordinary that until the 1960s or thereabouts, when Sir Richard Doll and his colleagues made the irrefutable connection between lung cancer and smoking, a pall of heavy cigarette smoke hung everywhere: in trains, cinemas, restaurants and especially in our own homes. My own father, a GP, was a 60-a-day man and I used to hear his smoker’s cough in the surgery as he was listening to his patients’ lungs, all hacking away with their own smoker’s cough. King George VI, a heavy smoker who died of lung cancer, was actually advised to smoke more, on the grounds that it would ease his stammer.

Libertarians grumble at the increasingly draconian measures that have come into force to stop us smoking in public. A few non-smokers have apparently taken up smoking in defiance. But smoking was ruining the nation’s health. When something like that becomes obvious the government has a duty to do something. I suspect the same will become true of our sugar intake. According to Johnson’s article, almost 20 per cent of London’s children are technically obese “and the proportion is rising all the time”. He points out, as if we didn’t already know it, that “This fatness plague is costing about a billion in extra healthcare costs in London alone; obesity is associated with diabetes, with heart disease, with some forms of cancer”.

I took my grandchildren to McDonald’s for a treat over half term; without meaning to sound like a patronising middle-class granny, it was a depressing spectacle: hordes of overweight children enthusiastically munching on the fatty and sugary in-house fare, alongside overweight adults also munching hard (while occupied with their mobile phones). They looked so at home I got the impression that they all lived at McDonald’s. I ordered three small milk shakes in different flavours, only to be presented with three large tubs. My grandson assured me they were the smallest size. If I were Mayor Bloomberg of New York I would be inclined to a whole host of drastic measures, not just tinkering around with the cup size of sugary drinks.

However, there are other ways of thinning the populace without trampling over freedom of choice. Carolyn Moynihan writes from New Zealand in the Family Edge blog that a millionaire businessman from Auckland, Tony Falkenstein, has come up with an imaginative response to the anti-fat war: he has distributed rent-free water coolers to thousands of homes in a poor part of the city and supplied families with filtered tap water at $1 a litre. He estimates that the consumption of fizzy drinks has fallen by 60 per cent in homes that have a water cooler.

It seems that Falkenstein got the idea from bringing home a water cooler for his own children. They could help themselves to a drink and use easy technology – pressing a button – at the same time. The psychology behind the idea is simple: you re-programme the brain to think that using a water cooler is as much fun as buying a fizzy drink.

My mother, who lived through the war, goes on about how good it all was when everyone had to travel about on bicycles and cook plain, nourishing fare; sugar was rationed “and everyone was healthy”. This is a nostalgic and simplistic view, obviously – but perhaps the Coalition should turn from peripheral concerns to combating its flabby, self-indulgent electorate? I advocate turning McDonald’s into 1940s-style theme parks where the milk shakes are strictly rationed.

Last Saturday night, Indian police raided a party in Banjara Hills, Hyderabad. They came away with 14 grams of cocaine, 10 packets of cube LSD, 10 small pills of micro LSD, five grams of MDMA drug and four LSD dots. And this was a party of just 15 young people, not some sort of rave. The Times of India is running with the headline: “Middle-class youth addicted to affordable drugs”. It’s the “middle-class” part that constitutes the story. Banjara Hills houses some of India’s richest young people – but these were youths from lower down the social ladder:

After the crackdown on the city’s cocaine nexus curbed the supply of the potent drug in the party circles, the cheaper MDMA and LSD have become the dope in demand among the city’s druggies. And it’s not just youngsters from the elite circles of the city who are hooked to drugs anymore. The affordable MDMA and LSD have become the drugs of choice among the middle class too. Anurag Sharma, Commissioner of Police, says, “The city trend is now that youngsters are taking to MDMA and LSD. MDMA in the original state is white crystalline powder and is called Ecstasy when sold as pills. Because it’s more affordable when compared to coke, it has caught the fancy of youngsters from all social strata. Earlier, only the city’s upper class was into drugs, but now the growing trend is that even youngsters from middle class families have become habitual drug abusers.”

This is how the globalisation of addiction, one of the themes of The Fix, takes hold: in small shifts up and down the social ladder, in a leap of a mile or two from village houses to villas, or vice versa.

India has at least four million drug addicts – and the number is growing: once recreational drugs penetrate lower-income communities, the total could number tens of millions. The Indian middle class is growing extremely fast, creating disorientation, new wealth and an appetite for sensation-seeking. For a drug baron, that’s the perfect emerging market.

Here’s more on the subject, from my Telegraph blog.

The Mail reports that a huge proportion of footballers are swallowing painkillers before matches – indeed, that nearly 40 per cent of players in the 2010 World Cup did so:

England’s footballers could be among those putting their careers and their health at risk at the European Championship over what has been described as painkiller ‘abuse’ by FIFA’s chief medical officer.

The British Journal of Sports Medicine has labelled it ‘potential disastrous practice’ but the Football Association refused to be drawn on the issue, even though the comments made by Dr Jiri Dvorak apply to all 16 nations in Poland and Ukraine.

In a study Dvorak found that 39 per cent of players at the 2010 World Cup were taking pain medication prior to every game; in particular anti- inflammatories that enable a footballer to play with an existing injury.

I wonder how many of these painkillers are opiate-based – and how many footballers develop a dependence on pills. I’m not denying that sports injuries can be agonising; but the use of painkillers as a preventative measure is closely related to the use of tranquillisers to ward off rather than treat anxiety. As The Fix emphasises, medication is just as potent a source of addiction as risk-taking experimentation.

The question is: once these footballers retire, will they keep themselves topped up with Nurofen Plus (or something stronger) in order to treat minor aches – and, perhaps, to continue enjoying that soothing opiate high? Here’s a warning note from America:

Doctors are seeing an increase in the number of current and former NFL players who are either addicted or physically dependent on painkillers. One doctor who treats athletes with addiction problems says pain medications are “10 times more common in sports than steroids.”

Prescription narcotics fall into the category of opioids, which include powerful drugs like morphine, codeine and heroin. Opioids attach to receptors in the central nervous system and prevent the brain from receiving pain messages. They also produce feelings of euphoria, and a”high” that many people using these drugs begin to crave. Long-term use of opioids, however, can alter immune system function and, ironically, increase pain sensitivity. Athletes often build up a tolerance to a given dose of the medication, thereby requiring more and more of the drug to get the same effect.

The eccentric Guardian journalist Tanya Gold had this to say about The Fix in the Guardian’s Comment is Free section yesterday:

And so to the book – The Fix, by Damian Thompson of the Telegraph. It is a strange creature, in part a poison pen letter to AA from a former member. It attacks the disease model of addiction, which has been the accepted dogma for more than 50 years, endorsed by almost every medical authority in America, where most of the research is done – the American Hospital Association, the American Public Health Association, the National Association of Social Workers, the American College of Physicians, the National Institute on Alcohol Abuse and Alcoholism.

For the vast majority of scientists, as Thompson acknowledges, you are no more responsible for being an addict than you are for having leprous limbs, even if this consensus has little impact on social policy where addicts are still treated with contempt. Even so, to dispute it is a popular game among libertarians. Last year the blogger Brendan O’Neill wrote a piece congratulating Amy Winehouse for not being suckered by the therapy industry, even as her ashes were interred in the mud. Thompson’s status as an ex-AA member renders The Fix a dangerous polemic that exposes addicts to social censure – a daft fate for sufferers of an illness so intrinsically dependent on self-hatred – and financial and occupational insecurity: it is almost impossible for addicts to be insured, even in 2012.

Thompson’s opening passage on alcoholism is anecdotal, brutal, subjective. He describes an AA member – in unflattering terms – who will likely recognise herself. He says the group “seemed almost proud they had this ‘disease’” – were they, or weren’t they? He insists the members “describe disasters that befall those who stray from the true path [with relish]“. Does he relate their testimony from memory, or did he take notes?

Thompson bases his complaint on the stories of two of his friends. Both abused alcohol and drugs: one lived, one threw himself off a building. His conclusion is that, since some addicts recover it cannot be a disease. So what is it? “The behaviour of addicts,” he concludes, “looks voluntary because it is … there will always be people who … change their mind and pull themselves out.”

What of the science? The most comprehensive study (by George Vaillant at Harvard) suggests that almost no one who drinks alcoholically ever drinks normally again; twin studies suggest addiction is hereditary; A Thomas McLellan’s enormous round-up of the data noted “higher rates of dependence among twins than among non-twin siblings and higher rates among monozygotic than dizygotic twins. Evidence,” he says, “suggests significant genetic contribution to the risk of addiction comparable to that seen in other chronic illnesses … the choice to try a drug may be voluntary, [but] the effects of the drug can be influenced profoundly by genetic factors.”

McLellan admits: “It is not yet possible to explain the physiologic and psychological processes that transform controlled, voluntary use of alcohol and other drugs into uncontrolled, involuntary dependence”, and this is the hole that Thompson crawls through. The Fix reads only like bitterness, an unconscious elegy to shame; add Iain Duncan Smith’s coerced AA meetings, and fair treatment for addicts feels, as ever, far away.

And here’s my response in today’s CiF. There is so much more one could say about colourful Tanya… and, who knows, perhaps I will before long.

Tanya Gold has accused me of writing “a poison pen letter” to Alcoholics Anonymous in my new book about addiction, The Fix. Since AA saved my life, that seems a very ungrateful thing for me to do. And, indeed, I’ve done nothing of the sort. What I have said is that I don’t buy the dogma that addiction is a disease. In that respect, I’m a 12-step heretic. The book has only been out for four days and already I can feel the flames licking around my feet.

It’s perfectly true, as Gold says, that most medical addiction specialists endorse the notion of addiction as an irreversible brain disorder. But, as I explain in The Fix, these specialists have borrowed this model from the 80-year-old doctrine of the steps, which are heavily influenced by the evangelical Christianity of “moral rearmament”.

Gold says I dismiss the disease model on the grounds that some people cure themselves of alcoholism. That’s true, up to a point: I’ve known apparently helplessly addicted drunks return to normal drinking. When this happens, AA purists retreat into circular logic. If these ex-drunks can enjoy the odd glass of wine now, then they can never have been alcoholics … because alcoholism is an irreversible disease.

There are plenty of reasons for rejecting the disease model. Perhaps the most compelling is that there is no test for addiction of the sort that exists for cancer or diabetes. There’s not even a posthumous test, as there is in the case of a notoriously difficult-to-diagnose illness, Alzheimer’s, unquestionably a disease. Two people can die of cirrhosis of the liver, one from drinking alcoholically and the other from carelessly heavy but controllable heavy drinking. If you cut their bodies open on the slab, will you be able to identify which had the “disease”? The answer is no.

My message is that addiction is behaviour – and it’s no less deadly for that. The conditions of the global free market are producing substances and experiences that target ever more effectively the pleasure centres in our brains. Perhaps the most important chemical involved is the neurotransmitter dopamine, which not only produces an agreeable buzz but also stokes up our desire. Self-described shopping addicts can experience the same hit from hearing the whirr of the debit card machine as a drunk does from the pop of a cork, or a cokehead from the chopping of a line. Anticipation is a powerful intoxicant.

I’m not denying that these people are addicts, if we adopt the sensible definition of addiction as excessive consumption that causes harm. But this consumption is behaviour that can be modified. For example, there is news this week of a pill that treats compulsive buying habits by suppressing impulsive urges. I bet it works – and not just on “shopaholics”. Shopping addicts may find it difficult or even impossible to control their purchases. That said, the architecture of their brains is not fundamentally different from that of non-addicts.

To put it simply, addictive urges are rooted in the human condition and can be placed on a spectrum from the “I really shouldn’t” reaction to another helping of pudding to the desperate plunge of a needle in an urban alleyway. Gold argues that the hereditary component to addiction supports the disease model. But there’s a genetic component to most behaviour, so one would expect addiction to run in families. There is, however, no single gene for addiction (nor the remotest prospect of one being discovered). A far better predictor of addictive behaviour than heredity is environment, and the conclusion of my book is that contemporary capitalism is ruthlessly targeting our mental reward circuits. The technology that tests computer games, fast food and painkillers is simply doing its job too well, making us like addictive things too much.

Back to Alcoholics Anonymous. If its disease model is wrong, why does it work so well? There’s no mystery. It takes drunks who want to stay sober and surrounds them with like-minded souls. The “programme” doesn’t manage disease: it creates an environment in which the temptation to drink ebbs away. Eighteen years, Tanya – that’s how long I’ve stayed away from alcohol. For which, as I make clear in the book, I’m truly grateful to AA.

UK technology magazine Wired has reviewed the The Fix:

The entrepreneurial spirit of technology is now infusing the social lives of young people who take the sorts of risks with their bodies that start-up founders take with their bank accounts. Thompson’s purpose in this new book is to ask: are we sure we know what we’re doing to ourselves?

The Fix runs the full gamut of food, shopping, sex, gaming and pornography addictions in the modern world. It explains how each is sliding dangerously out of control, suggesting that the primary purpose of government in the future may be the management and treatment of its citizens’ addictions.

It also, with gentle but terrifyingly persuasive regularity, reminds us of the red thread running through all this: the rapid advances in technology that are creating a widening gap between the evolutionary progress of our bodies and minds and the disorientating world around us.

Read the full review here.

My essay based on The Fix is the Spectator’s cover story this week:

When future generations look back at the early 21st century, they may well decide that its political turmoil — the collapse of the euro, the spread of Islam, the rise of China — pales into insignificance next to a far more important development: a fundamental change in the relationship between human beings and their social environment.

This was the moment in history, they may conclude, when our species mastered the art of manipulating its brain chemistry to produce intense bursts of short-term pleasure. As a result, billions of people began to have more fun than their minds and bodies could handle — and developed insidious, life-sapping addictions.

Already, the distinction between ‘addicts’ and ordinary people is far less clear than it was even 20 years ago. The line between consumption, habit and addiction is becoming dangerously blurred.

It’s not difficult to find evidence that appetites are spinning out of control. At Victoria Station, young commuters pant like elderly spaniels after rushing to catch their train. Many of them are clutching over-filled baguettes; they have to lick the mayonnaise off their fingers before fishing for their ­tickets.

Other travellers are hovering over a gigantic free-standing food counter loaded with thousands of pieces of loose candy: jelly beans, toffee, bonbons, liquorice sticks, fudge and lollipops, all glistening with artificial colouring. These sugar addicts look furtive as they scoop the sweets into the paper bags. Anyone would think they were buying pornography, from the way their shoulders hunch and their eyes dart sideways.

Not that many of today’s porn connoisseurs have to go through the ordeal of scanning the top shelf in the newsagents. That embarrassment has been made redundant by technology. More than 150 million people visit porn sites every year, and the figure will soon rise into the hundreds of millions as the developing world hooks up to the internet.

The numbers tell only part of the story, however. It’s not just that digital technology creates unprecedented desire for pornography; the images themselves are shockingly explicit compared with most pre-digital porn. Never before have so many nice people discovered that they have depraved sexual tastes. Husbands who would once have retreated to their dens to pore over car magazines now download videos of ‘teen sluts’ being violently penetrated and gasping for more.

The difference between old-fashioned porn and internet porn is a bit like the difference between wine and spirits. After hundreds of years as a mild intoxicant, erotica has undergone a sudden distillation. Digital porn is the equivalent of cheap gin in Georgian England: a reliable if unhygienic hit that relieves misery and boredom. And, unlike the old ‘dirty mags’, it is available in limitless quantities.

You can read the rest free of charge on the Speccie’s website here.

Here’s a brave article about sexual predators in Alcoholics Anonymous. A young woman is talking about her experiences of “the rooms” and of the older men who may have kicked their addiction to alcohol but can’t keep their hands off vulnerable girls:

The young people’s meetings I went to all over Los Angeles featured a revolving cast of men that I would call perverts. They weren’t the obvious kind of creeps, either, with windowless white vans and long trench coats. They looked like everyone else at the meetings: tattooed and cool and smoking cigarettes.

These men swarmed me, as they did every other newcomer too young and inexperienced to distinguish between the loving hand of AA and the clammy hand of a predator. They welcomed me to the meetings, they gave me over-long hugs, they offered me smokes when I was still too young to buy my own. I felt absolutely enveloped by the program. I had never had so many people pay attention to me in my life.

But what I thought of as harmless flirting—and all flirting is harmless when you’re 17 and your curfew is 10 pm—these men rightly interpreted as vulnerability.

There was J, who asked me to his house to “read the Big Book.” When I arrived and asked what we were going to read, he laughed and showed me to his bedroom. I let him kiss me and grope me because I didn’t know I was allowed to say no. He was a grown-up; I was a kid. He’d been sober 15 years; I’d been sober a few months. He was in his 30s; I was 17. My parents had taught me to respect adults, and that’s what I thought I was doing. It can’t be wrong or immoral if J is doing it, I thought; he has a million sponsees and he’s a grown-up.

There was C, who was 36 and also had double-digit sobriety. He had a daughter a few years younger than me. It’s strange to look back and call it rape—because I’ve been assaulted under much less ambiguous circumstances—but that’s absolutely what it was.

I heard about this sort of problem when I started attending 12-step meetings in London in the mid-1990s. Sexual advances were known as “the 13th step” and one very famous rock musician was notorious for trying it on with female AA members. Obviously this type of behaviour wasn’t unique to AA: you also find it in other moralistic groups where older people wield spiritual power over younger ones – evangelical churches, for example. And I need hardly mention the Catholic Church’s record in this respect. Still, I can’t recall reading an article on 12-step predators before, so all credit to thefix.com (no relation to this website) for running it.

From Chapter 8 of The Fix, which is entitled “Gambling, the new Gaming”. If you wondered why it was so hard to tear yourself away from your “harmless” computer game, here are some clues:

It isn’t just children who are getting trapped in cyberspace. Increasingly, we’re taking our toys with us into adulthood. Like those fun cognitive-enhancing drugs, social technol- ogy is meddling with the boundaries between ‘work’ and ‘play’. Where previously a service like Twitter, which is essentially a chat application like the MSN Messenger of the 1990s, would have been regarded as a social plaything, it’s now part of the professional arsenal of communi- cative tools – sometimes even replacing email as a primary means of communication in the office.

But Twitter is different from email in important ways. Like other ‘web 2.0’ products of the past decade, it is becoming increasingly ‘gamified’, as product companies pick up tips from gaming engineers about how to keep people hooked on their services. Your old email client was never designed to keep you in it for as long as possible, but Twitter is.

And consider Foursquare, an application that lets you ‘check in’ to real world venues to let your friends know where you are at any given moment. (Mysteriously, the need to check in is felt most strongly by users when they are eating in a swanky restaurant or arriving in an exotic foreign city.) Foursquare awards ‘badges’ for various levels of accomplishments – ‘achievements’, they’re called – using language and user interface elements that are plucked straight from a video game.

Applications developers look to social gaming companies such as Zynga in San Francisco for tips when building their products, because they know that the games its engineers create are among the most addictive experiences on the internet.

One of the ways developers such as Zynga keep people hooked is with ‘design cues’, elements of the user interface that signal some sort of reward. These get people excited and, like other addictive cues, generate dopamine.

In the case of Zynga’s FarmVille, players receive visual hits every time they accomplish a task: for example, when they water or harvest a square of crops, they’re treated to a short animation and cutesy sound effect. And as they watch the gold coins they’ve earned from growing and selling pile up in their virtual handbags, and are also rewarded for their actions with the pleasing ‘whoosh’ sound, they’re encouraged to repeat those actions.

What’s interesting is that such actions should be ‘rewarded’ at all. People who suffer from obsessive-compulsive disorders rarely derive any reward from them, but in this case meaningless, repetitive OCD-style actions are encouraged rather than frowned upon. It’s not by accident that these pieces of software deluge the user with little fixes of social reinforcement and ego massage.

Significantly, these tricks are being picked up by non-gaming soft- ware companies. Modern applications are engineered to provide dozens of little hits per hour: the modern computer is becoming over- loaded with intrusive notifications from Skype, Twitter, email, Facebook and any other software with a communication component. There’s a piece of software for Macintosh computers called Growl that was specifically designed to streamline the various notifications. In practice, it’s almost as invasive as the higgledy-piggledy world of indi- vidual notifications: it showers dozens of translucent rectangles across the screen every time a programme wants your attention. Infuriating, you might think. But the people who install Growl welcome the distraction. It makes them feel needed – and if the stream of notifica- tions slows down they wonder why.

The user interfaces of applications that perform perfunctory office functions are beginning to resemble dashboards. Apple’s OS X actually has a dashboard. The Dock, from which applications can be launched, has red status indicators – which are there to tell you, for example, that you have unread email. They are lifted directly from the video games of the late 1990s.

The result of this crafty borrowing is that people find it ever more difficult to drag themselves away from the screen. They admit as much, even if they don’t use the word ‘addicted’. But in terms of stickiness and brain-hijacking, every operating system pales in comparison with the latest video games…

There’s a real storm brewing over DSM-V’s inclusion of behavioural addictions in next year’s manual. On the one hand, it’s clear that some “process” addictions – to gambling and internet porn, for example – have a compulsive quality that can ruin lives. But there’s no getting around it: the wider you cast your net, the more the addiction therapy industry stands to gain. Here’s a sceptical report from Pittsburgh Post-Gazette:

It is often said, on everything from oil to junk food, that we’re a nation of addicts. That adage will have greater meaning if the American Psychiatric Association adopts broad new definitions of addiction next year in the manual that shapes the nation’s approach to mental illness

The Diagnostic and Statistical Manual of Mental Disorders is undergoing revision, and one part to come under fire is a proposed expansion of the list of symptoms for drug and alcohol addiction. Critics fear that the looser language could mean millions more people being classified as addicts, thereby creating expensive consequences for health insurers and the public.

The association would be wise to reconsider its proposals.

The New York Times reported that the new manual, which will be published in May 2013, would list gambling as an addiction for the first time and might include the broad new category of “behavioral addiction — not otherwise specified.” Some public health experts, according to the Times, fear that classification could be overused by doctors to diagnose patients with addictions to the Internet, video games, shopping or sex.

The biggest controversy, however, is over how the proposal recasts drug and alcohol addiction. The current definition requires serious outcomes like being arrested, driving under the influence or missing work or school for a person to be diagnosed with alcohol abuse. The new approach views addiction as a continuum, with those displaying at least two less-problematic behaviors, such as craving alcohol or drinking more than they should, being seen as mild addicts.

One study says this could result in 60 percent more people being classified as addicted to alcohol. A Stanford psychology professor who was a White House drug policy adviser believes up to 20 million people could be newly tagged as substance abusers.

All these new diagnoses will carry a price tag. The association argues they could get abusers into treatment earlier while critics fear they will only raise medical and insurance costs.

Although costlier, late-stage medical intervention for any affliction can be headed off by early treatment, we fear a different kind of financial consequence: a flood of new low-level diagnoses overwhelming the health care system and resulting in a shift of dollars away from patients who really need help.

Brent Robbins, an associate professor of psychology at Point State Park University, gave this sensible assessment to Post-Gazette reporter Anya Sostek for a story published Friday:

“Everyone who goes to frat parties at age 19 and drinks too much doesn’t have an addiction. They are abusing the substance, clearly, but that’s very different from someone who has an addiction. The difference between substance dependent and substance abuse is being lost, and that’s not a good thing.”

Other professionals agree, hence the controversy. If the psychiatric association wants its new manual to garner respect and have integrity, it should reconsider its proposed changes and weigh their far-reaching impact.

The Fix argues that addictive behaviour is one of the most serious challenges facing humanity – but it’s also critical of 12-step entrepreneurs who slap addiction diagnoses on basically healthy people and encourage them to define themselves by their “issues”. As the report above says, “all these new diagnoses will carry a price tag”. And not a cheap one, either.

New drugs are pouring on to the streets of India without having undergone proper clinical trials. That’s what the journal Nature is claiming and it doesn’t surprise me in the least. In fact, welcome to the future. Here’s a quote from the story:

India’s drug-regulatory system is failing in its job, according to a report from an Indian parliamentary committee. The report found evidence that pharmaceutical companies exploit loopholes in Indian law and sometimes collude with the drug-regulatory authority to get licences for their products without adequate tests being done.

The result?

As part of its analysis, the [Indian] parliamentary committee reviewed the approval process for 42 randomly selected drugs, most of which were awarded licences between 2004 and 2010. Documentation for three of the drugs — which the report describes as “controversial” because they are not licensed for use in most Western nations — was missing, and 11 of the remaining 39 had been licensed apparently without undergoing phase III clinical trials.

As I mention in The Fix, Big Pharma is scared of developing psychotropic drugs because so many of them – tranquillisers, anti-depressants, cognitive enhancers – have side-effects that trigger lawsuits. But could the developing world act as a laboratory for testing these medicines?

A point to remember: there are illicit labs all over the developing world which produce fake or rip-off pharmaceutical drugs that cross the medication/recreation barrier. They put pressure on major companies to meet demand (without being sued out of existence, of course). The situation is getting messier by the day.

Here’s an important question. India has a fast-rising population of 1.2 billion. By the time it reaches 2 billion, how many Indians will be taking licit or illicit pills for medical and/or recreational purposes?

I’ve written a blog post in the Telegraph about the unintended consequences of DSM-V’s decision to scrap the abuse/dependence distinction and replace it with varying degrees of “addiction”.

Up to 40 per cent of student drinkers could be classified as alcoholics, according to the revised “bible” of psychiatry, scheduled for publication next May.

I know what you’re thinking: only 40 per cent? Have these guys been anywhere near a college pub crawl?

But, actually, the new criteria set out by the American diagnostic manual DSM-V could end up doing something really stupid: that is, persuading four out of ten student drinkers that they are suffering from a “disease”, which is how most addiction specialists in the America and Britain (heavily influenced by Alcoholics Anonymous) regard addiction.

Here’s the problem: earlier DSM volumes distinguished between “abuse” of drugs and “dependence” on them. The first term is now regarded as too judgmental (of course) and the second is regarded as unscientific, because dependence on something isn’t the same thing as addiction. Are diabetics addicted to insulin, for example?

As this article from Time explains, DSM-V “will have just one diagnosis for addiction problems, though it will be characterised as either mild, moderate or severe”. So student boozers who get wasted once a week could be labelled as “mildly” addicted. And the result? As Time points out, since the name for alcohol addiction is alcoholism, the new manual “will also tremendously elevate the number of people considered alcoholics. One Australian study suggested that using DSM-V definitions will increase the number of people diagnosed with alcoholism by a stunning 60 per cent.”

As I stress in The Fix, there is a continuum between university binge drinking and alcoholism – I found myself sliding along it. I have no idea at which point I became an alcoholic. How long is a piece of string? “Addiction” is a complex phenomenon. On the one hand, if DSM-V recognises the existence of that continuum, that’s a good thing. But if it means shoehorning mildly or potentially addicted youngsters into the disease model, enabling 12-step groups to diagnose them with a lifelong, incurable illness, then the reform will achieve nothing and probably make matters worse.

Doctors are testing a drug that could stop alcohol making people drunk, says the Daily Mail. The researchers believe iomazenil, taken before drinking, might negate some of alcohol’s effects on the brain.

How popular do you think this drug will be? Here’s a clue. Ask yourself: how many people would drink alcohol if it didn’t alter their mood? (And there is, of course, absolutely no way of distinguishing between the mood-enhancing properties of alcohol and its intoxicating effects.)

As The Fix makes clear, the ability of alcohol to get you pissed is making it more, not less, popular. Binge drinking is about mood, not flavour. In fact, when students gather to get slaughtered together, it’s noticeable that many of them will be drinking cocktails or alcopops whose selling point is that they disguise the unpalatable taste of alcohol.

One of the purposes of iomazenil is to protect us from drunk drivers. I’m sceptical. If you’ve got to be sober at the end of the evening, why not stick to soft drinks, rather than slurping the same number of pints as your mates but without the buzz? I’d say iomazenil would make being the designated driver an even more miserable experience than it is at the moment.

Believe me, this new drug will not catch on. Alcohol is a drug and that’s why people take it.

Did you see those Chinese schoolchildren hooked up to drips while they were studying? I’ve got a piece in today’s Daily Telegraph which points out that much more far-reaching “cognitive enhancement” in happening in schools and universities in the West – and spreading.

The creepiest image published this week shows Chinese teenagers hooked up to IV drips in a classroom, feeding amino acids into their bloodstreams so they can concentrate harder on their National College Entrance Exam. The school, in Xiaogong, central China, is unapologetic. Parents ask for the drips, it says, because otherwise their children become exhausted swotting for examinations that will determine the course of their lives.

It’s easy to jump to conclusions. Those ruthless Asians! So this is where the “tiger mom” thing leads – to a jab of the needle to make sure the homework gets done and your son or daughter ends up working for a bank rather than assembling iPhones and thinking about topping themselves.

But hang on. In America between 2003 and 2007, the number of parent-reported cases of Attention Deficit Hyperactivity Disorder (ADHD) increased by nearly a quarter. That’s a million extra children taking medicines far, far stronger than amino acids.

Let’s leave aside the sensitive question of whether ADHD is real. Instead, we should ask: how many of the millions of Ritalin and Adderall pills handed out for ADHD are taken by students who weren’t prescribed them, but who have traded them from friends or siblings?

Attention-deficit pills are popular with young people for two reasons. First, since most of them are amphetamine-based, they can give you a nice buzz. Second, you can be cognitively “normal” and still find your concentration magically boosted. Which is handy, if you’re just about to sit SATs or college exams.

Last summer I sat in the canteen of one of America’s most expensive universities. I was interviewing a professor for The Fix about the use of doping as a study-enhancing tool. He said there was a lot of it about. But I could have worked that out for myself, because in the background we could hear college kids discussing how much Adderall they’d need to finish their term papers.

The rest of the article is here. And for a discussion of Oxbridge students swallowing modafinil, see The Fix.

The Mail claims today that Britain is addicted to sleeping pills:

Britain has become a nation of sleeping pill addicts since the start of the  economic downturn, figures revealed yesterday.

Stress-related insomnia has been blamed for a sharp increase in the number of people prescribed powerful drugs to help them sleep.

The annual cost to the NHS of handing out the pills has risen by a sixth in the past three years to nearly £50 million.

According to the paper, figures obtained from health trusts under a freedom of information request reveal that in 2011 15.3 million prescriptions were handed out for sleeping pills, compared with 14.5million in 2007/8. Last year the NHS spent £49.2 million on such drugs, up from £42 million three years previously.

I’d like to know what proportion of this was spent on zopiclone, a Rhône-Poulenc drug often sold under the brand name Zimovane. Most of my friends with sleeping problems are given zopiclone, originally considered less addictive than the benzodiazepines. Well, I got addicted to it, as I describe in The Fix. It wasn’t a fun experience, at least after some initial euphoric feelings: it felt “dirtier” than Valium and certainly produced a poor quality of sleep.

Zopiclone has also become a street drug, as I describe in the book:

A report by Dr Russell Newcombe published in 2009 by the charity Lifeline revealed that ‘zimmies’ (from Zimovane) were a popular street drug in the north-east of England – sometimes in the form of 15 mg tablets not available in the UK, which suggests that they came from an internet pharmacy.

One interviewee said heavy zopiclone users ‘looked really evil’, with their bloodshot eyes, messy hair, untidy clothes, drooling mouth and drunken sailor’s gait. ‘Trying to sit down can take them half an hour – it has to be seen to be believed, if it wasn’t so sad it would be funny.’ No wonder my friends gave me a wide berth. But those were the worst cases. For regular all-night partygoers, ‘zimmies’ were something to help you come down after a night on stimulants.

I wonder if some of the NHS money is unwittingly being spent on zopiclone and other tranquillisers for the benefit of recreational users who need a post-binge downer and lie to their GPs about insomnia.

For legal reasons, I haven’t quoted the opinion of a hospital doctor who took part in the original trials of zopiclone in the 1980s and whom I talked to a few years later. Let’s just say that it was pretty harsh.

If you want evidence of how drug-saturated the streets of Baltimore are, consider this: last year the actress who played one of The Wire’s most memorable characters pleaded guilty to conspiracy to distribute heroin. Felicia Pearson – known as “Snoop” on the show and in real life – was caught on a wiretap conspiring with two others, who bought heroin in bulk from New York and distributed the drugs in Baltimore.

David Simon, who created the show, reacted to Pearson’s arrest by telling Slate:

The war on drugs has devolved into a war on the underclass, that in places like West and East Baltimore, where the drug economy is now the only factory still hiring and where the educational system is so crippled that the vast majority of children are trained only for the corners, a legal campaign to imprison our most vulnerable and damaged citizens is little more than amoral.

Let’s leave aside – for the moment – Simon’s campaign to change US drug policy. I’m interested in his statement that “the drug economy is now the only factory still hiring”. That touches on one of the major themes of The Fix – that availability of drugs is the main factor in how many people take them, NOT their susceptibility to a “disease”.

The vast majority of Baltimore kids are trained only for the corners, says Simon. And they’re not like the classic drug dealers of legend, selling junk but never touching it themselves. As The Wire’s five seasons made clear, getting high was their favourite recreation. Only having sex rivalled it – but sex while high, of course.

Drug-taking in Baltimore doesn’t spread like the plague: it spreads like other self-destructive habits. It has more in common with stuffing yourself with junk food than with a disease. More on this in the book, but if you want a historical analogy, look at the picture below.

Let’s get one thing straight about the Ritalin and Adderall that are taken by millions of schoolchildren in the Western world. They are not just amphetamines – that is, speed – but an especially mellow, user-friendly form of speed. They are highly prized recreational drugs. High school students prescribed them for ADD or ADHD have no problem at all selling them to classmates.

In The Fix I describe the time I took Adderall in America. It blew my head off – turned me into a gibbering (but happy) idiot:

The blues didn’t hit me until the next day – and took the best part of a week to banish.

And this is what they give to restless nine-year-olds. Defenders of the practice say kids with attention deficit who take Adderall and Ritalin, another amphetamine-based stimulant, are given the gift of concentration without the potentially addictive high. They don’t experience the chemical thrill I felt because their brain deficiency cancels out the chemical thrill I experienced.

I’ve always been suspicious of this argument, so I was interested to read, in January 2012, an article in the New York Times by L. Alan Sroufe, a retired professor of child psychology who has closely monitored the pharmaceutical treatment of children with ADD for over 30 years. Sroufe now believes that millions of children diagnosed with ADD are being treated for brain abnormalities that they don’t actually have – that their genuine behavioural problems, which like all behaviour are governed by the brain, are often induced by environmental factors. Yes, Adderall and Ritalin calmed them down in the classroom. But, said Sroufe, the drugs have the same effect on all children, not just those diagnosed with attention deficit.

Also, like anyone else who takes stimulant drugs, these children develop a tolerance to them. As he put it: ‘Many parents who take their children off the drugs find that behaviour worsens, which most likely confirms their belief that the drugs work. But the behaviour worsens because the children’s bodies have become adapted to the drug. Adults may have similar reactions if they suddenly cut back on coffee, or stop smoking.’

One can’t help suspecting that the children themselves worked out most of this a long time ago. They know Adderall and Ritalin can be used to get high. That’s why some of them claim to have ADD or ADHD: the symptoms aren’t exactly hard to fake, after all. And that’s why some kids with legitimate prescriptions are happy to sell their pills to classmates – or to let their mother or father ‘borrow’ a few. Older siblings, too, like to get hold of these drugs: what could be nicer than a mellow form of speed that enhances the experience of video games and sex?

It’s easy to assume that internet pornography unleashes an uncontrollable sex urge – and that’s why (to put it delicately) men drive themselves to exhaustion in front of their monitors. But there’s more and more evidence that, like computer games, online erotica latches on to obsessive-compulsive traits in our personality. It’s a subject I explore in a long chapter of The Fix devoted to internet porn – probably the addiction that worries the experts most:

Internet pornography can unearth obsessive-compulsive traits. Enter the words ‘collector jailed’ into a search engine, and you immediately come across stories about the compulsive hoarding of internet porn. An accounts clerk from Lincolnshire was jailed for downloading the largest collection of child pornography discovered in the UK – 500,000 images. In Pittsburgh, a man was jailed after police found 60 hard drives filled with images of underage girls; the defence tried to claim that Tourette’s syndrome had led him to collect them compulsively. In any case hoarding on this scale would have been impossible without access to internet porn. These cases came to light because the material was illegal – but we should also bear in mind that the same technology allows men to amass large collections of images that may be explicit but don’t actually break the law. It’s hard to see, in fact, how anyone with an obsessive-compulsive personality and a weakness for online porn can avoid getting the two mixed up. The internet enables users to painlessly download and catalogue thousands of files; arranging them is often part of the fun of owning a personal computer. Add sex to the experience, and collecting porn can turn into an all-consuming pastime.

Unexpected good sense from Russell Brand at the House of Commons home affairs select committee on drugs. Sure, he flirted with the – unproven and misleading – notion of addiction as a “disease”, but he also said that alcohol and drugs were “inextricably linked”.

This is what middle-aged addiction experts so often get wrong. They remember their own university days, when drink and drugs were quite separate experiences, and taking an illegal drug (with the possible exception of a drag on a joint) was an adventure.

Not any more. I won’t have to tell anyone under the age of 30 this, but clubbing often involves a pre-planned trajectory of booze, powder and pills. It’s one of the themes of The Fix, in which I speak to a psychiatrist in the Accident and Emergency department of a London hospital whose job involves asking young patients about their drug and alcohol history.

‘As soon as they know I’m not going to rat on them, most of them admit to doing something – coke, MDMA, mephedrone, ketamine – in the previous few days,’ he says.

‘What the older generation doesn’t understand is that combining drugs and alcohol is normal for young clubbers. They might do a bit of coke before they go out, or “pre-loading” with a few drinks, then go to a bar and get drunk, do a line of coke in the loos and stop drinking. If they go on to a club they’ll drop a pill – or maybe pure MDMA, because no one trusts Ecstasy these days. They don’t know what’s in it. The last thing they want to do then is drink and many of the clubs won’t even serve alcohol anyway. Then they go back to someone’s house and want to come down, so they use Zopiclone, Zolpidem or Valium.’

Much more on this in the book…