User talk:Seppi333

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Sex addiction[edit]

Hi: I've left a note for you on the sex addiction talk page, as requested, explaining why I removed that material from the article. -- The Anome (talk) 23:11, 9 September 2014 (UTC)

I see you've done something similar in the substance dependence article. While the FOSB stuff looks plausible, I think it's radically oversimplifying things to state that it is the mechanism of addiction, as if the matter was settled beyond doubt, and these massive text dumps go way beyond what's needed.

What would make more sense, and would meet the WP:NPOV requirement, would be a statement on the lines of "Several researches, most notably Dr. X and Professor Y, have put forward the hypothesis that ...", and then point the reader at the FOSB article for more detail. -- The Anome (talk) 23:33, 9 September 2014 (UTC)

I can't put it any more clearly: the reviews you are quoting make clear statements that delta FOSB is implicated in the process of sexual addiction, but other practitioners, equally legitimately, claim that sexual addiction is not actually a real thing. Logically, they can't both be right, and there is thus a legitimate difference of opinion between experts. In this case, WP:NPOV is the only way this can be resolved. -- The Anome (talk) 21:02, 13 September 2014 (UTC)

@The Anome: The distinction has to do with how addiction is being modeled. In the DSM diagnostic framework and the addiction pharmacology paradigm, sexual addiction literally cannot be diagnosed by anything other than an observation of true compulsive behavior. The metrics the DSM uses are designed/intended for drugs, and it ends up being relatively useless for behavioral addictions. If you look up table 1 in the review that cites the giant table I transclude, you'll notice that sex addiction is the exception to withdrawal symptoms of any sort. I excluded that row from the wikipedia table because withdrawal can occur for non-addictive drugs (i.e., it's not entirely useful for determining if a drug is addictive; it's probably useless for determining "addictive behaviors". There's no dependence associated with sex because withdrawal doesn't occur. Tolerance also makes no sense in this context, so it's effectively useless for diagnosis. So, it SHOULD be difficult to diagnose in that framework.
The "reward-reinforcement" framework I mentioned isn't too much more complicated than what is taught in college intro psych classes. An addictive drug is literally defined as one which is both (positively-)reinforcing and rewarding (involves reward center activation). Several behaviors implicated in behavioral addictions, including sex, fit all the characteristics of a being "rewarding" as well as "reinforcing" (the use of these terms comes up frequently in the sex addiction papers). It's a neuropsychological model, and it's much more useful for identifying and determining relationships between addictive drugs (or addictive behaviors, or between the two types) for some obvious and some esoteric reasons. It's also the current basis of clinically identifying what behaviors are addicting, from which a more useful diagnostic framework can be developed. All of this research is simply the foundation for identifying metrics to clinically identify behavioral addictions without them having to become ruinously compulsive before identifying. Established diagnostic criteria (what clinicians use) does not precede the research used in establishing those criteria or identifying the addiction (which is model specific) in the first place.
With that said, the ONLY way an argument in current "debate" could be relevant to this, is if a "clinician" or researcher argues that sex can not result in a compulsive disorder of any kind (as in the lead sentence of addiction, which is accurately defined). It's worth noting that if the term "dependence" is used in an argument to refer to an addiction, the argument model-specific to a distinct paradigm, and therefore not relevant to ΔFosB (the two frameworks have nothing notable in common). If there's current peer reviewed literature (preferably a medical review, but I'd be ok with a primary source that's published by a credible group) arguing that truly compulsive sexual behavior (analogous to the definition in addiction) is not possible, or it argues against the rewarding/reinforcing properties of sex, I'll accept your reworded version involving controversy. Seppi333 (Insert  | Maintained) 22:17, 13 September 2014 (UTC)
Two things I probably should note as well:
  • Clinicians don't ever use the research framework of addiction, so I'd be surprised if they make any arguments relevant to it.
  • If this material actually did conflict with another authoritative body of research, I find it highly highly doubtful that any respectable journal would ever go through with publishing a medical review that makes significant claims without any qualification or coverage of differing viewpoints somewhere in the review. It's called a literature review for a reason. Seppi333 (Insert  | Maintained) 22:27, 13 September 2014 (UTC)
Highly respectable journals publish all sorts of things, and science and medicine contain many disparate communities of researchers. I think you can say with great certainty that one particular community of serious scientists working in the context of one particular conceptual model of addiction now all agree that what they call "sexual addiction" is certainly correlated with, and quite possibly entirely explained by, FOSB activity. But they are not the only group of people studying sexual addiction. Various groups of equally serious clinicians and psychologists have also studied it from their own perspective, and come up with entirely different conclusions.
You say above "clinicians don't ever use [the] research framework of addiction, so I'd be surprised if they make any arguments relevant to it." That's exactly my point. They are talking in entirely different terms of reference. You might as well say that the reward-reinforcement people aren't talking in terms of models used by clinicians, and that they don't make any arguments relevant to it.
It's not clear who's right, and it's not our position as Wikipedians to say that one group of researchers are right, and another wrong. In fifty years' time, this will probably be settled science. But at the moment, we just have no way of knowing which group is right. We just can't say that molecular biology and neuroscience trump psychology or clinical medicine because one is "real" science and the other isn't. Hence WP:NPOV.
Myself, I'm quite prepared to believe in the FOSB hypothesis, but I think we should wait for the experts in those respective fields to resolve their differences before Wikipedia reports it as uncontroversial fact, and NPOV is no longer needed. -- The Anome (talk) 23:01, 13 September 2014 (UTC)
On review: Actually, I think this is a key insight. The article is called "sexual addiction", but different groups of people use that name to mean entirely different things, and that's why it's hard to achieve a consensus on this. The reward-reinforcement people mean one thing (that thing you make rats do that is found to correlate to FOSB activity when you autopsy them), psychologists another (the thing where people say they're unhappy they're having so much sex, and can't seem to stop), psychiatrists another (the thing that does not appear to have any objective attributes to define it as a real thing, and therefore doesn't "exist" in any meaningful sense), and the moralists another (the thing where someone you disapprove of is having more sex than you are). And the public and popular press are even more confused: it vacillates between "that sexy thing it's tittilating to read about, and here's a picture of an alleged sufferer in her underwear", and "that awful menace that threatens our children". As a result, it's very hard to write a single article on the topic.
Do you agree that this might be the problem here? If so, perhaps one way to proceed would be to put more emphasis on the differences between the different conceptions of the term. -- The Anome (talk) 23:33, 13 September 2014 (UTC)
@The Anome: That's exactly the point I've been trying to make! Face-smile.svg There's actually little coverage of these topics on wikipedia, which is unfortunate; but, I've been rewriting the addiction section of a textbook that Nestler coauthored, so hopefully I'll be able to put this material somewhere.
This is their definition of addiction.[1] This is a snippet on the pharmacology addiction model.[2] This is a snippet on the reward-reinforcement model.[3] That chapter of the textbook does a very good job at explaining addiction and both models if you're interested in reading about them. Seppi333 (Insert  | Maintained) 23:47, 13 September 2014 (UTC)
  1. ^ Malenka RC, Nestler EJ, Hyman SE (2009). "Chapter 15: Reinforcement and Addictive Disorders". In Sydor A, Brown RY. Molecular Neuropharmacology: A Foundation for Clinical Neuroscience (2nd ed.). New York: McGraw-Hill Medical. pp. 364–365, 375. ISBN 9780071481274. "The defining feature of addiction is compulsive, out-of-control drug use, despite negative consequences. ...
    compulsive eating, shopping, gambling, and sex–so-called “natural addictions”– ... these pleasurable behaviors may excessively activate reward-reinforcement mechanisms in susceptible individuals. ..."
  2. ^ Malenka RC, Nestler EJ, Hyman SE (2009). "Chapter 15: Reinforcement and Addictive Disorders". In Sydor A, Brown RY. Molecular Neuropharmacology: A Foundation for Clinical Neuroscience (2nd ed.). New York: McGraw-Hill Medical. ISBN 9780071481274. "Familiar pharmacologic terms such as tolerance, dependence, and sensitization are useful in describing some of the time-dependent processes that underlie addiction.
    Tolerance refers to...
    Pharmacokinetic tolerance is caused by..., whereas pharmacodynamic tolerance is a result...
    Sensitization, also referred to as reverse tolerance, occur when...
    Dependence is defined as an adaptive state that develops in response to repeated drug administration, and is unmasked during withdrawal, which occurs when drug taking stops.
    Dependence from long-term drug use may have both a somatic component, manifested by physical symptoms, and an emotional–motivation component, manifested by dysphoria. While physical dependence and withdrawal occur with some drugs of abuse (opiates, ethanol), these phenomena are not useful in the diagnosis of addiction because they do not occur with other drugs of abuse (cocaine, amphetamine) and can occur with many drugs that are not abused (propranolol, clonidine).
    The official diagnosis of drug addiction by the Diagnostic and Statistic Manual of Mental Disorders (2000), which makes distinctions between drug use, abuse, and substance dependence, is flawed. First, diagnosis of drug use versus abuse can be arbitrary and reflect cultural norms, not medical phenomena. Second, the term substance dependence implies that dependence is the primary pharmacologic phenomenon underlying addiction, which is likely not true, as tolerance, sensitization, and learning and memory also play central roles. It is ironic and unfortunate that the Manual avoids use of the term addiction, which provides the best description of the clinical syndrome."
  3. ^ Malenka RC, Nestler EJ, Hyman SE (2009). "Chapter 15: Reinforcement and Addictive Disorders". In Sydor A, Brown RY. Molecular Neuropharmacology: A Foundation for Clinical Neuroscience (2nd ed.). New York: McGraw-Hill Medical. pp. 365–366. ISBN 9780071481274. "The reinforcing effects of drugs can be demonstrated in animals, where rodents and nonhuman primates readily self-administer certain drugs … The strength with which certain drugs reinforce behavior in animals correlates well with their tendency to reinforce drug-seeking behavior in humans. The neural substrates that underlie the perception of reward and the phenomenon of positive reinforcement are a set of interconnected forebrain structures called brain reward pathways; these include the nucleus accumbens (NAc; the major component of the ventral striatum), the basal forebrain (components of which have been termed the extended amygdala, as discussed later in this chapter), hippocampus, hypothalamus, and frontal regions of the cerebral cortex. Addictive drugs are rewarding and reinforcing because they act in brain reward pathways to enhance dopamine release or the effects of dopamine in the NAc or related structures, or because they produce effects similar to dopamine." 
Excellent! I think we are in agreement about the problem. In regard to the reward-reinforcement model, I think you're spot on -- there really is no serious disagreement that the FOSB hypothesis is the current settled scientific consensus in that specific context. But not everyone is talking about the same thing when they use the term "sexual addiction". I'll put my list below, to invite your comments...

──────────────────────────────────────────────────────────────────────────────────────────────────── List of possible meanings of the term "sexual addiction" in descending order of seriousness

  • A specific model of behaviour used by neuroscientists and molecular biologists to describe animal behavior, and therefore also very likely has correspondences to similar human behavior
  • a term not used as a diagnosis by the psychiatric community, due to lack of non-subjective criteria to diagnose it, and therefore regarded by some of them as completely meaningless
  • a term used by psychologists to describe a person's experience when they are having more sex than they would like to have, and it distresses them that they cannot stop doing it
  • a term used by moralists to disparage those who are having more sex than they admit to having themselves
  • a term used by the popular press to desribe promiscuity, often in a salacious manner
  • a term used by the popular press to create moral panic
  • a concept that has no meaning at all to the general public, who have been exposed to any or all of these, and don't know what to think

Note that the first two groups both have science on their side, and both have, from their respective terms of reference, clear justification for their beliefs. The neuroscientists have clearly identifiable biochemical pathways, and animal experiments which meet the statistical standards of proper science. The psychiatrists point to the fuzziness of the human conception of "sexual addiction", which is so far undefined as a clinical entity, because of the absence of any serious evidence that such a thing exists in humans in a way that might meet the serious standards of evidence-based medicine.

-- The Anome (talk) 00:01, 14 September 2014 (UTC) ──────────────────────────────────────────────────────────────────────────────────────────────────── That looks good! It should help explain some of the different perspectives on this. I like the last two the most, but they might be hard to cite... Seppi333 (Insert  | Maintained) 00:09, 14 September 2014 (UTC)

Good! We've got our work cut out, though, to make the article reflect this, as it will need a complete refactoring to do it. Sadly, I've got to stop editing for now, but I'll be very happy to work with you over the forthcoming days to refactor the article into a form that I believe will be satisfactory from both of our viewpoints. -- The Anome (talk) 00:19, 14 September 2014 (UTC)


Hi! My apologies (again...) for not reacting to your ping. I've been more or less off-wiki lately, and I'm of course completely out of sync with your FA review. Anything I can do? Cheers, ἀνυπόδητος (talk) 08:18, 14 September 2014 (UTC)

@Anypodetos: Hey! Thanks for leaving the note; the FA reviewers suggested I contact everyone from previous nominations for any input on the article for feedback. The article is more or less the same since you reviewed it, with exception to the overdose section which has a lot of new content on the mechanism of amphetamine addiction and behavioral treatments. If you have the time, it'd be great if you could do a short review of that at the current FA nomination page; don't worry about it if you don't have the time though! Also, thanks again for your thorough review in the earlier FA nomination! Seppi333 (Insert  | Maintained) 07:20, 16 September 2014 (UTC)

Medical Translation Newsletter Aug./Sept. 2014[edit]

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Medical Translation Newsletter
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Feature – Ebola articles[edit]

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