General Question

FlyingWolf's avatar

Is addiction a disease?

Asked by FlyingWolf (2496 points ) 2 months ago

This question has been asked before, but it was three years ago and there has been much turnover of jellies in that time. What’s your take? Do you think addiction is a disease or does sobriety come down to willpower (or luck or something else)? If you are willing to share, have you ever dealt with an addiction of your own and how does that color your opinion?

Personally I am several years sober. I feel fortunate that when I realized alcohol was disrupting my life I was able to make the decision to quit and stick with it.

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46 Answers

Espiritus_Corvus's avatar

Yes. Anything that makes you it’s bitch is a disease. You don’t control compulsions and this alone should put any whole person ill at ease. This includes substances, any innocuous yet compulsive behaviour, and people. Dis-ease. Whole-some-ness. Antonyms.

And, yes, to get rid of it requires will power, among other things, depending upon the individual and the pathological source.

GloPro's avatar

Yes, it is a disease. It has been genetically linked, and runs in families.

I was a drug abuse counselor for my senior internship for my Psychology degree. I was so naive, thinking that because I do not have an addictive personality I could teach that to others. After 9 months of watching 32 clients fail, and hate themselves, and destroy their lives, and destroy the lives of their loved ones, and be tortured, I can definitively tell you it does NOT come down to willpower. It’s heartbreaking.

Of the 32 patients I had, I felt only 2 could beat their demons. One of those 2 died from an overdose 2 months after my internship ended. I signed up for a double major that day, knowing I didn’t have what it takes to be in psychology.

People that believe addiction is just an issue with willpower have never truly been addicted.

Espiritus_Corvus's avatar

@GloPro
It does come down to willpower. We can offer all the therapy, change of environment, medication known to man, but without the will to stop their destructive behaviour, it is all for naught. None of it will work. Willpower is the most important element in the therapeutic matrix. If the individual hasn’t even the desire to change and adapt, nothing short of death or severe chemical restraint (incapacitation) can make them do it.

It also requires courage, which is a quality absent in our society, even much maligned.

Khajuria9's avatar

Definitely a disease.

hearkat's avatar

I think that there are many facets to addiction and numerous underlying causes. Some addicts become so because they are self-medicating for mental health issues – in this case, the addiction results from their treatment for a different disease. Some people have ‘addictive personalities’ which is again a mental health issue. However, in time we may learn that there are biochemical reasons for some people to crave certain substances. Then there’s the aspect where the addiction also contributes to mental health problems over time.

I am nowhere near an expert on the topic, nor in touch with the latest research, but I currently feel that the mental health aspect is where we can currently make the biggest difference for people. Helping them find healthier alternatives to cope with the anxiety, depression, stress, etc. that they turn to their addiction for. “Willpower” is also a mental health concept, right? Valuing oneself in order to put your true best interests first, even if that means going through the physical pains and mental anguish of withdrawing from the addiction. Once the biochemical sciences can offer more insight and better treatments, I think that mental health services are crucial to the prevention and treatment of addiction.

My personal experience is my ex-husband, the child of two alcoholics, who was fraught with anxiety and self-loathing. 2 of 3 in his generation killed themselves wither via drug/alcohol abuse or direct suicide. Of the six in the next generation (one of whom is my son) 2 are dead from drug overdoses, 2 have problems with anxiety/depression and alcohol/drug use, 1 is questionable, and one seems to be holding up pretty well. There’s 7 in the next generation (4 over 13) and only one of them has significant drug/alcohol problems. My observation is that it’s near impossible to tell if it’s the addiction that’s inherited or the anxiety – it’s a chicken/egg scenario.

FlyingWolf's avatar

I tend to think of alcoholism as a disease and it leaves me wanting to be compassionate toward people struggling with it. The flip side though is someone we know who has been fighting to stay sober for close to 30 years and has literally lost everything (her home, her kids, jobs, her health, her marriage). She has been gone to rehab after rehab and has never managed to quit for more than a year at the most. She is at the end of her rope at this point, homeless, physically and mentally falling apart, broke, but she still drinks. So does one cut someone like that loose, or keep trying to help them find the cure that might work for them?

dappled_leaves's avatar

Whether or not it can be overcome using willpower has no bearing on its characterization as a disease. If you think a disease is only something that is contagious, perhaps you need to revisit its definition.

However, saying that alcoholism is a disease does not mean that you automatically have to accept the dogmatic twelve step approach to overcoming it. Twelve step programs are not for everyone (they’re certainly not for people who don’t believe in a higer power, for instance). There are many different approaches to overcoming alcohol addiction – it’s great that you found your own way.

GloPro's avatar

@Espiritus_Corvus Although willpower is most certainly a component, it is not what it “comes down to.” Ask anyone who has drank mouthwash because it was the only alcohol they had access to. That is desperation to the fullest extent. They might literally DIE of withdrawal symptoms if they do not consume alcohol. If NOT doing something can kill you, I fail to see how in the world you believe it comes down to willpower.

FlyingWolf's avatar

@dappled_leaves I am not sure where you got the idea that I only classify disease as something that is contagious, but that was certainly not my insinuation. I am fully aware that cancer and heart disease are examples of real diseases that are not contagious.

It is my understanding that not only do 12 step programs not work for everyone, in actuality they work for very few people. I’m aware that there are no easy answers and that I am lucky to be able to maintain sobriety.

zenvelo's avatar

@Espiritus_Corvus Willpower has nothing to do with recovery. Addiction is the inability to have will power persevere. Most alcoholics and addicts I know (and, being a recovering alcoholic myself I know quite a few) will tell you the strength of an addict’s willpower is demonstrated by the extent they will go to keep from getting clean.

Most recovery models are successful based on the concept that even the strongest willpower is inadequate and that to recover one needs assistance.

LornaLove's avatar

Love @hearkat answer. I am in recovery and had my last drink in 1988. I also came from a long line of alcoholics. What I will say is that we all had/have mental disorders, anxiety, depression and other issues. My son I believes ‘self-medicates’ too. I stopped, I believe by experiencing a ‘spiritual revelation’. I had no will power at all.

Espiritus_Corvus's avatar

It comes down to will power because without will power, you can have all the other ingredients of therapy, and the abuser will still fail. This makes willpower the intregral ingredient, the one ingredient that sobriety cannot succeed without. What you describe is compulsive behaviour. A person who has lost control of themselves, have lost their instinct for survival over their dependence on one thing or another, in this case a substance. The one thing that is missing is willpower to stop. They need to get it back in order to regain control. This is both simple in theory and the hardest thing in the world to accomplish.

What you say is true, many abusers, will die if they go cold turkey. Nothing new here. That is why there are withdrawal unit drug protocols, whole cocktails of drugs given to the patient in order to get them through the initial stages of abstenance. Sadly, alcohol being a legal drug and easily obtainable, many alcoholics wait too long before seeking help and die during this phase. Their organs are shot from years of abuse and they can’t handle it. Rehabs lose more alcoholics than any other type of abuser this way. So, what’s your point, Glopro? The same result would occur soon in the alley.

After the initial stages of withdrawal, comes the communicative stage, where the abuser is sober and can begin dealing with the problem. Very few of these people simply got caught up in a cycle of partying and one day found themselves dependent. There is always a backstory to self medication. And this has to be dealt with, confronted, and it takes courage to do this and willpower to not go running off and self-medicating, thereby avoiding the process, ending back at square one, and back into that cycle of destroying themselves and all the people around them. Courage. Will Power. The cycle of compulsive behaviour cannot be broken without it.

I think you mentioned once that you’ve worked the ER. I have respect for that, as so have I. Then you know that when someone comes in, say, a guy who fell face first into a powered-up outboard motor prop while he was flushing out the saltwater, you don’t get all freaked out at the fact that there is nothing left of his face but burger and gristle, because you’re too busy setting the IV access for the MSO4 and at the same time looking for a significant bleed coming form the damaged areas. The MSO4 is as much for the patient as it is for the medical team, because as important as it is to relieve any suffering the patient may be experiencing, it is also necessary that the patient is not thrashing about, resisting the medical team while they are attempting to address the most immediate problems. The MSO4 not only helps to reduce the pain levels, but by doing so, we get a more cooperative patient to work on. We need a modicum of cooperation in order to get this person through.

It’s much the same with treating abusers. You don’t get emotionally hung up in all the bullshit, the sad and horrible things they often do to themselves and their loved ones, you treat the problem. And in order to do this, you require their assistance. They have to have the will to get better, through that will they must find the courage to confront and make sense of all that bullshit describe above, or you are just wasting your time.

I’m sorry, but you sound like someone who is still in shock after their first visit to critical care psych unit.

GloPro's avatar

That was 10+ years ago. Trust me, I’m not in shock. I just disagree that having willpower is all it takes to control compulsive behaviors.

Emergency medicine is a different scenario. I have held many hands of trauma patients that have told me they can’t do this, they can’t. The difference is they have no choice. Their body is broken, that’s the reality, and it must be fixed. The medical care to save someone is out of the hands of the victim. We save them. They live. They don’t always want to. Them surviving is largely independent of willpower to do so. I do believe trauma brings out survival instinct. Different topic.

Someone fighting a disease has a choice on whether or not to fight or roll over. Fighters are more often survivors, it’s true, but it’s one component of the entire treatment. As you said, they can fight, but alcoholics don’t always live.

hearkat's avatar

I also want to ask people what they think about other addictions that aren’t related to substance abuse? Gambling, sex, shopping, videogames, etc.? Those actions change the neurochemicals in the brain without the introduction of an outside chemical.

FlyingWolf's avatar

@Espiritus_Corvus something I have thought about for a long time is that if we agree that alcoholism is a disease, can we liken the willpower it takes to overcome the disease to the willpower it takes to seek and accept help for any other disease?

When my aunt found a lump in her breast she could not bring herself to see a doctor because she didn’t want to hear it was cancer. Was it a lack of willpower that led her to ignore the lump until the cancer had spread and eventually killed her? It might be considered analogous to the user who doesn’t have the willpower to find and adhere to a treatment plan that works for them.

Espiritus_Corvus's avatar

I never said willpower is all it takes. I said that homeostasis cannot be achieved without it.

Coloma's avatar

I agree that is is about ‘dis-ease”, the dis-ease of mind and spirit. It is also physical, which has nothing to do with willpower. It is about rewarding the pleasure centers of the brain and neuro-pathways that are always lying in wait to flare up again when fed. I have smoked on and off forever now and have gone lengthy periods without, but as soon as the stress ramps up the old brain craves a nicotine fix.

This is why the old saying that a habit will always carry ” a-bit” and it takes extreme presence to overcome cravings once those pleasure centers have been conditioned to their particular reward. While smoking is not good I would say however that it does not carry the same weight and stigma nor cause an extreme altered state of mind and behavior.
Humans are humans and I’m pretty sure whoever first discovered the honey comb or fermented fruit thousands of years ago had their addictions as well.

Any substance or behavior cam become compulsive to assuage stress and anxiety, sex, drugs, food, nicotine, even exercise. Look at hoarders and those with OCD, those behaviors are addictions as well. All behaviors meant to keep anxiety at bay.

FlyingWolf's avatar

@Espiritus_Corvus I’m thinking that the willpower and treatment go hand in hand in the treatment of many chronic diseases. If we are trying to treat high blood pressure we have to have the willpower and commitment to eat right and stick to an exercise program. To treat anything, whether it is addiction, arthritis, or a low thyroid, we have to be willing to seek out the help and adhere to the treatment plan. Part of the treatment plan for addiction is the whole “people, places, and things” aspect of using.

Espiritus_Corvus's avatar

@Flyingwolf Precisely. That is why in my first post to this thread I included all diseases, of the mind and of the body, in the statement.

@zenvelo Only people who lay down and die suffer the absence of willpower. There is a modicum in even those whose lives are so miserable that they envy the dead, evidenced by the fact that they haven’t yet taken that step to join them.

You seem to think I exclude assistance as a component to getting well. I’ve excluded nothing. Whatever works for the individual and many people require assistance. The success rate statistics are miserable enough without excluding things that have worked for others. And to walk through that door and ask for assistance,, first and foremost this requires a spark of will—the will to once again live in sobriety. Then, to stay and work the problem, requires further development of one’s will power. Courage and will power. They are like muscles as they require exercise or they will atrophy.

And it is not the strength of an addict’s willpower that is exhibited by lengths in which they will go to not get clean. What you describe is the strength of the addict’s denial.

I really don’t understand why this concept is so bloody difficult to grasp here. Has the definition of will changed in the past few years, to something unnecessary, or undesirable? Has the word been abused and perverted in my absences from America by some unpopular blowhard or series of events? It’s happened before.

GloPro's avatar

I think it’s the statement that it “all comes down to willpower” that has thrown people off.

Espiritus_Corvus's avatar

Bloody hell. All this for one clause. Too conversational. OK. I understand now how that reads. Thank you, Glopro.

Willpower—the want, the wish, the determination, the commitment to get better—is possibly the most important element in the complex therapeutic matrix to all diseases, but willpower alone is not enough.

That is what I meant.

That was my meaning.

ARE_you_kidding_me's avatar

Will power can be a powerful tool against addiction. That’s all I needed to quit a 5 year smoking habit. Addiction has a broad range of causes, forms and intensity levels. Is the cause chemical, emotional? Can a person just “quit” like smoking or could quitting actually kill them like severe alcoholism? That takes more than willpower, it also takes psychological and medical intervention. In the end the person must still want to quit and that is firmly planted in willpower. It has to be at the core of any recovery if there is ever going to be one. It does really come down to that.

El_Cadejo's avatar

I don’t believe it’s a disease, never believed it was a disease. Calling it such seems like more of a scape goat than anything else to me. Man up and admit you have a drug/drinking/sex/gambling whatever problem, don’t blame it on some thing you can’t control.

FWIW I consider myself addicted to quite a few things.

Coloma's avatar

@El_Cadejo I used to feel the same way until I understood what the disease model really means.
It means that addiction left untreated is a progressive condition than can, and often does, lead to death. Just like untreated cancer or any other progressive condition. This is why addiction is called a disease.

El_Cadejo's avatar

@Coloma I get what you’re saying, but I don’t agree to call it a disease. Call it something different because it’s not a medical disease IMO.

zenvelo's avatar

@El_Cadejo The interesting thing is, if you’re not dealing with your own addiction, it really doesn’t matter what you think about the disease model. You can’t cure anybody, and you don;t know what it is really like to be enthralled by alcohol or drugs.

If you are really addicted, it’s a model to get you into recovery.

Alcoholism and addiction are not moral issues. It’s a physical condition coupled with a psychological condition. That is why the disease model works.

El_Cadejo's avatar

@zenvelo “The interesting thing is, if you’re not dealing with your own addiction, it really doesn’t matter what you think about the disease model. You can’t cure anybody, and you don;t know what it is really like to be enthralled by alcohol or drugs.”

Then why are we even answering a question here about OUR opinion if we think it’s a disease?

zenvelo's avatar

@El_Cadejo I can only imagine why the OP is asking; yet he is also asking those with a personal experience what their opinion is.

Alcoholism is really the only self-diagnosed illness as far as recovering it is concerned. A million people can tell you you are an alcoholic, but until you admit it to yourself you can’t recover from it.

El_Cadejo's avatar

@zenvelo “Alcoholism is really the only self-diagnosed illness as far as recovering it is concerned. A million people can tell you you are an alcoholic, but until you admit it to yourself you can’t recover from it.”

I’d replace alcoholism with addiction there, but overall I agree. Like I said I have issue calling it an illness or disease, it’s shifting responsibility away from yourself. Like it’s something you can’t help. I am addicted to nicotine, I’m fully 100% aware of it. I’m addicted because nicotine is an addictive substance that I use too often thus building the bodies “need” for it, it’s not because I have some disease.

kevbo's avatar

I’m a full-time employee for a 12-Step program and regularly read stories of recovery sent in by program participants.

I also have experience with addiction and cessation, although my personal journey in this regard had nothing to do with a 12-Step program.

I won’t say my answer is universal, but it is my experience and it is reflected in the stories I’ve read.

12-Step programs focus on physical, emotional and spiritual recovery. Many times (and I include my own cessation in this) the spiritual component takes care of the rest, and once someone finds and latches on to that conduit, it produces a dramatic change. There’s a common saying in these programs that goes something like: “Don’t give up before the miracle happens.” In my understanding, this would be the miracle.

I would personally go further and say that there is literally demon energy that sustains addiction. This I base only on my personal experience of having and having seen this kind of energy extricated. (To be clear, these events happened outside of any 12-Step program.)

Statements that 12-Step programs do or don’t work can’t really be verified by anyone due to the anonymity hard wired into 12-Step programs. But saying it doesn’t work is like saying “true” Christianity doesn’t work. It’s less a matter of whether it works as whether it has been tried. The 12 Steps often aren’t tried in earnest (something else I’ve read many times). They are a structure for recovery, but the addict literally has to embrace them 24/7. If an addict can hold on long enough and work in earnest, recovery is bound to happen.

That said, 12 Steps are not necessary. For me, it was one step—just getting in touch with my version of divinity. The rest is taking care of itself. 12-Step programs do good, though, for a lot of people who are ready for that experience.

My personal understanding of addiction is that it is a form of karma. It is a spirit’s (one’s own or a parasitic’s) fascination with suffering and with exhausting the experience of a “vice.” For the longest time, I was baffled at how addicts could physically survive all the abuse they put their bodies through. Now I see that the action is really taking place on a spiritual level and that we mostly stick around until that level of play is exhausted.

One last note, atheists and agnostics in 12-Step programs are free to fashion a Higher Power (the programs’ language for “God”) however they choose. Many regard their group or meeting as their Higher Power or maybe their sponsor. It really doesn’t matter. The point is to turn their decision making about their addictive behavior over to something or someone that is capable of guiding their actions in a way that they have proven through repeated failures that they cannot manage successfully.

FlyingWolf's avatar

@zenvelo for the record I am asking because we are currently in the thick of dealing with someone who has literally lost everything because of her addiction to alcohol. We are the last people in her world she has not totally alienated (including her three grown children) now she is turning to us (DH and me) for help. This is a woman who has been in and out of rehab tons of times over the years and just can’t stay sober.

I am contemplating how to do the right thing for a fellow human. I am wondering whether to be compassionate and supportive of someone living with a chronic disease or frustrated as hell and ready to cut someone out of our lives who has steadfastly refused to hold on to the life preservers she has been tossed so many times over the years when what is really required to maintain sobriety is some willpower. I understand that is a very simplistic explanation because I tried to boil it down to the bare bones.

The responses in this thread have given me lots of food for thought.

Coloma's avatar

@FlyingWolf Tough call and position to be in. Just don’t fall into a codependent trap, rescuing her inspite of the consequences. Being supportive is good, enabling her to continue her addiction while being rewarded with help is codependent. Good luck!

kevbo's avatar

I’m not familiar with Al-Anon, which is designed to support the people affected by an alcoholic. If your question is what to do, it may be worthwhile to sit in on a meeting and hear what people focused on this problem are doing. Meetings are free, so it only costs your time. You can find a meeting on their website.

FlyingWolf's avatar

@Coloma yep, that is my biggest concern about this situation. It seems to me that many addicts, especially those who have lived this lifestyle over an extended period of time (in her case over 25 years), have a reflexive need to draw people in to become enmeshed with. She has rekindled this relationship over the past couple of weeks and has already crossed those boundaries more than once with late night desperate phone calls, asking our help to solve her problems, etc.

Honestly my inclination at this point is to tell her the help she needs is beyond our capability, but I have an ethical issue with deserting someone begging for help using the last lifeline she has.

dappled_leaves's avatar

@FlyingWolf “I am wondering whether to be compassionate and supportive of someone living with a chronic disease or frustrated as hell and ready to cut someone out of our lives who has steadfastly refused to hold on to the life preservers she has been tossed so many times over the years when what is really required to maintain sobriety is some willpower”

Well… there’s no reason you can’t feel all of these things at the same time. Calling alcoholism a disease does not absolve the sufferer of all personal responsibility. They still must act to get themselves sober.

hearkat's avatar

My experience in dealing with my husband’s addiction is in great detail here: http://www.fluther.com/153506/am-i-in-the-wrong-here/#quip2613521

For me, the biggest factor of knowing when it is time to cut one’s losses with the addict is when they are clearly consumed by the addiction, and incapable of rational thought. My ex loved our son so intensely, yet he still could not get beyond the addiction and only got worse. He hit rock bottom the night his liver gave out on him and he died. Some people are beyond help and just can’t get better.

If you are the only ones left for this person, it becomes even harder to walk away knowing they may not make it once there is no one left. Your compassion is admirable, since you are even considering offering to help this person. It is a tough love that’s needed, because the addict has to truly want to change and have the humility to seek and appreciate the help. Should you decide to do so, you and your husband have to set agreed-upon ground rules and be prepared to follow-through. At the first sign that you are being taken for granted or advantage of, you have to be willing to follow-through with consequences.

You say that they’re already pushing the boundaries with the late night phone calls, so you have to tell them point blank that those are not acceptable, and explain exactly what behaviours you will tolerate and what you will not. If they want to be in your life they have to show that they are taking every possible action to change their ways, and that you can not and will not rescue them, but will be there to offer support and encouragement as long as they show that they really want to turn their lives around.

I’ve often said that love is unconditional, but life isn’t. Always put your own well-being, and that of your family, first.

Coloma's avatar

@FlyingWolf Ugh…the late night drama phone calls. I dropped an old friend decades ago now that had drinking issues and would violate my boundaries by calling at 11 at night, or even later, drunk and crying and completely incoherent. I had a toddler at the time and a husband that got up for work at 5 a.m. I had to let her go. Never did find out what became of her, oh well.

zenvelo's avatar

@FlyingWolf

Ah, the problem of the chronic relapser.

I know of a number of people that just never seem to get any time under their belt, and bounce in and out of recovery. It has seemed to me that such people have a deep lack of self worthiness, that what it takes is their finally understanding that they are as worthy and deserving of recovery and of being loved as anyone else.

So, my advice would be to talk to her when she has a week or so clean, about how you cannot enable her and you cannot get her sober, she has to do it, but that you are there to support her as long as she is sober.

And, she needs to be told that you value her as a person, and that she is deserving of being loved and clean. And, that her act of getting sober is actually of service to others. And ask her directly, what will she do that is different this time? And let her know you are not confronting her, you are working to find out how you can best support her recovery.

But you have to be tough too, and let her know you will not enable her, not get her booze, not give her money, not do anything to protect her from the consequences of her drinking.

My best wishes for you and for her, you are in my prayers.

ARE_you_kidding_me's avatar

@hearkat That’s a touching story, I’m so sorry. 39 is really young for that even with alcoholism. Was there something else wrong or was he really drinking that much?

FlyingWolf's avatar

@hearkat, thank you for sharing such a personal story.

@zenvelo, thank you for the insight, laying it out the way you did was exactly what I needed.

hearkat's avatar

@ARE_you_kidding_me – Thank you; I replied via a message, so as not to derail the thread.

@FlyingWolf – You’re welcome. I think it was bookended well bt @zenvelo‘s comment – I tried to help my ex feel loved and wanted, and he did love being a father; but nothing any of us did could convince him that he was deserving of happiness. So while your aim is to help convince this person that they are loved and worthy of it, be prepared that they may not be capable of believing it.

It was a hard enough lesson for me to learn, and the only thin that finally changed my perspective was telling a young teen who was dealing with things that I dealt with that she was worth so much better than how she had been treated. I’m wondering if there’s any scenario where this person might be in a position to give advice to younger people, and how that might send some messages home – even if it was just that exercise that we often do here on Fluther, “If you could go back in time and say anything to your _ (age) self, what would you say?”

Dan_Lyons's avatar

Is addiction a disease?

Yes, when it comes with negative connotations and no it is not when the addiction has positive results.

Unbroken's avatar

I think addiction is an overused term. I don’t think it is a disease. It is an excuse for a crappy life in which the addictions make it worse. Lack of self control.

Saying it is a disease is a copout. On the other hand it is borne too often out of a sense of familiarity. As well as hopelessness.

Helping people regardless of the cause of their problems is a great thing. Personal boundaries are essential though.

DipanshiK's avatar

Lissa Rankin’s book ’ Mind over medicine’ describes how the mind can alter the body’s mechanism. If the patient decides to mould his mind towards the positive change then he surely can be disease-free. There have been examples of last stage cancer patients getting rid of this malicious disease solely on the believe that they can be be better. This positive attitude has lend them a beautiful life.
I believe that willpower is a key ingredient in being sober. I am not saying it is the only thing required to achieve balance. But it is indeed a very significant part. Addiction is a disease. And so it can be cured with willpower and proper attention.

FlyingWolf's avatar

@DipanshiK, your post made me think of Gregg Braden.

DipanshiK's avatar

Oh, really? I hope that helps. :)

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