Skip to content
Spiral Staircase
Buy the book
Menu

Chapter 14 of the book

Wanting, Loving, Losing, Meaning

ProbableEvidence grade: Probable. Good observational evidence with a plausible mechanism, or small or few trials.4 things to start with2 popular claims graded75 works cited

How the chapter opens

In 1970 and 1971, as Army enlisted men left Vietnam, the military tested their urine for opiates on the way out, and almost eleven in every hundred tested positive. In September 1971, a research team led by Lee Robins drew a random sample of the men departing that month, added a second sample of men whose departure tests had been positive, and set out to interview them after they got home.

What the interviews found about Vietnam was alarming. Before arriving, fewer than one man in a hundred had ever been addicted. In Vietnam, almost half tried narcotics and a third tried heroin, which was cheap, pure and easy to find. One in five said that at some point there they had felt strung out or addicted, and the team checked frequency, duration and withdrawal before accepting the claims.

What the chapter covers

The argument, the studies and the stories are in the book. Get the book.

  • ·Wanting
  • ·What Wanting Gets Instead
  • ·Loving
  • ·Losing
  • ·Meaning

Mismatch card

The system

The reward system (dopamine-driven wanting) and the attachment systems that bond, grieve and seek a role.

What it expects

Rewards that are scarce, variable and diluted; a partner and a small group met every day; losses mourned with others; a role the group depends on.

What it gets

Pure, cheap, constant drugs and betting on a phone, with close relationships, mourning and purpose left to arrange themselves.

What happens in the gap

Substance use disorders in about 15 percent of Americans aged twelve and over, just over half of them mild; a rise in mortality after bereavement, sharpest in the first months and in men; higher mortality with low purpose in cohorts.

The handrail

Tend the closest relationship; keep a recurring role; change the setting and use the treatments that work; lean on people after a loss (ProbableEvidence grade: Probable. Good observational evidence with a plausible mechanism, or small or few trials.)

Strength of evidence

ProbableEvidence grade: Probable. Good observational evidence with a plausible mechanism, or small or few trials. The treatments for addiction, couples and prolonged grief rest on trials; the links from relationships, purpose and belonging to longer life rest on large but confounded cohorts.

What you've heard

Popular claims this chapter tests, each with the book's verdict and grade.

The protocol

Each action carries the book's evidence grade. How the grades work.

Start here

There is one action for each part of this chapter. Skip any that do not fit your life.

  1. Invest in the quality of your closest relationship, and get couple therapy if it is in trouble

    ProbableEvidence grade: Probable. Good observational evidence with a plausible mechanism, or small or few trials.StrongEvidence grade: Strong. Multiple randomized controlled trials, or consistent large cohort studies with a well-understood mechanism.

    How: set a fixed, phone-free time together each week, even half an hour after the children are in bed, and when an argument turns hostile, stop and come back to it later. If the relationship is distressed, find a couple therapist, or start with a structured online program such as OurRelationship if cost or access is a barrier. Why: quality, not status, carries the health link, and couple therapy has large effects.

  2. Take on a recurring role, about two hours a week

    ProbableEvidence grade: Probable. Good observational evidence with a plausible mechanism, or small or few trials.

    How: a volunteering shift, a standing commitment to a person or a group that meets regularly and expects you, a project that would go undone without you. Put it on the calendar like a class. Why: purpose and regular volunteering are consistently linked to lower mortality, though no trial has shown they cause it.

  3. If a substance or habit has a grip, change your surroundings, and ask about medicine alongside it

    ProbableEvidence grade: Probable. Good observational evidence with a plausible mechanism, or small or few trials.for the settingStrongEvidence grade: Strong. Multiple randomized controlled trials, or consistent large cohort studies with a well-understood mechanism.for the alcohol medicines

    How: take the supply out of the house, change the routes, places and company tied to use, and put something rewarding in the gap, ideally something with people in it. If you have been drinking heavily for a long time, talk to a doctor before you stop. If you drink too much, ask a doctor about acamprosate or naltrexone; for opioids, ask about methadone or buprenorphine. Your doctor sets the dose, and before starting naltrexone, tell your doctor about every medicine you use, especially opioid painkillers. Why: the veterans' surroundings changed and most stopped, and the medicines help many who need more than that; a new setting does not replace treatment for a moderate or severe disorder.

  4. After a death, lean on people

    ProbableEvidence grade: Probable. Good observational evidence with a plausible mechanism, or small or few trials.

    How: accept help with meals, errands and paperwork in the first weeks and months. **If grief still dominates daily life six to twelve months on, ask for grief-specific therapy (StrongEvidence grade: Strong. Multiple randomized controlled trials, or consistent large cohort studies with a well-understood mechanism.),** such as complicated grief treatment. Why: most people adapt without treatment, and for those who do not, a targeted therapy works.

Then, pick from this menu

  • **Try a mutual-help group, or ask for twelve-step facilitation (StrongEvidence grade: Strong. Multiple randomized controlled trials, or consistent large cohort studies with a well-understood mechanism.).** It is free and at least as good as other therapies for drinking.

  • **If you bet, keep betting apps off your phone, set deposit limits, and never chase losses (EmergingEvidence grade: Emerging. Early, small, animal-only, or actively contested.).** Young men carry most of the risk. These tactics follow from the risk data; nobody has tested them.

  • **Take thirty days off a behavior that has stopped feeling like a choice (EmergingEvidence grade: Emerging. Early, small, animal-only, or actively contested.).** This is ordinary overuse territory, such as a game, a feed or a nightly drink. It is not a treatment for dependence, and not for heavy, long-term drinking: see Safety.

  • **If you are at high risk of heart disease, keep taking your medicines in the days after a loss, and treat chest pain as an emergency (ProbableEvidence grade: Probable. Good observational evidence with a plausible mechanism, or small or few trials.).**

  • **Treat depression that comes with grief (ProbableEvidence grade: Probable. Good observational evidence with a plausible mechanism, or small or few trials.).** An antidepressant added to grief therapy eased depressive symptoms, though not the grief itself.

  • **Take an awe walk once a week (EmergingEvidence grade: Emerging. Early, small, animal-only, or actively contested.).** Fifteen minutes outdoors, looking for things vast or new.

  • **After a loss, mark it with a ritual of your own (EmergingEvidence grade: Emerging. Early, small, animal-only, or actively contested.).** Something small and repeated, on a date or at a place that mattered: in short experiments, rituals eased grief even for people who did not believe in them.

  • **Aim for sex that satisfies you both, not a quota, and raise sexual problems with a clinician (ProbableEvidence grade: Probable. Good observational evidence with a plausible mechanism, or small or few trials.).** In couples, the link with well-being flattened above about once a week. From the late fifties on, half of sexually active people had a bothersome problem and few had told a doctor. New erectile problems also warrant a heart check (Chapter 16).

If this is you

Night shifts

the 3 a.m. break is where the cigarette and the energy drink live, so plan a replacement for that break specifically.

New in a city, and dating

there is no health reason to settle. Put your effort into two or three people you see often, and let the apps be one route among several (Chapters 11 and 12).

Young children at home

your time together can be short and at home, after bedtime. An online couple program with coach calls fits around children more easily than weekly appointments.

Perimenopause

if desire or comfort changes, raise it with a clinician early rather than waiting; Chapter 15 covers the transition.

After menopause

in the national survey of adults aged fifty-seven and over, low desire and vaginal dryness were among the commonest problems women reported. Both are worth raising with a clinician.

Widowed or bereaved

the first six months are the riskiest for your own health, especially for men. Keep your appointments and medicines, and let people in.

Someone you know is bereaved

offer a specific job, a meal or an errand, and keep offering into the third month and beyond.

Over 50

sexual problems are common and rarely discussed with doctors; raise them. If walking hurts, choose a seated role: tutoring, phone befriending, the paperwork for a club.

Someone you love is using

the treatments above work for them too, and for opioids, staying on medication is linked to far lower death rates. Helping them get to a prescriber may be the most useful thing you do.

Tight budget

mutual-help groups, volunteering, rituals and awe walks are free, and a structured online couple program costs far less than therapy.

Short on time

pick one, a weekly role or one protected evening with your partner, and keep it; the evidence is for regular roles, not occasional ones.

Safety

If you have been drinking heavily for a long time, do not stop abruptly without medical advice, because alcohol withdrawal can be life-threatening. Do not use weight-loss drugs of the semaglutide type to treat drinking outside a trial or a doctor's care: in three small trials heavy drinking tended to fall but other drinking measures often did not, and the drugs are not approved for this. Couple therapy is not the right first step where there is violence or coercive control; the person at risk needs individual safety support first. If grief or anything else brings thoughts of suicide, get help now: call or text 988 in the United States, or your local emergency number. Do not stop a prescribed medicine without your clinician.31

The skeptic's box

What could overturn this chapter, from the chapter itself.

Much of this chapter rests on observational evidence. The veterans were not randomized, and the few who entered treatment were probably the most severe, so the study cannot show that treatment is useless, only that setting mattered. The purpose, volunteering and religion findings share one weakness: illness lowers participation before death, and people who volunteer or attend were healthier to begin with. The health benefits of good relationships are small and correlational, and the sex trends rest on self-report. The harm from sports betting is not settled either: one small American study that followed bettors for two years found no clear change in problem gambling. The strongest evidence here is for the treatments, which all have trials. Open questions remain: whether addiction is best seen as a brain disease, a hijack or deep learning, and how much of the veterans' recovery would carry over to people who became addicted at home, among their own cues.32 If large cohorts that tracked purpose before illness found the link vanishing, the Meaning section would shrink to a matter of taste, and that would be worth knowing.

Go deeper in the reference library

The research this chapter was built from, as longer reference entries: each with its own mismatch card, graded recommendations and the case against it.

See also in the book

Sources behind this page

  1. 32.Heilig, M., MacKillop, J., Martinez, D., Rehm, J., et al. (2021). "Addiction as a brain disease revised: why it still matters, and the need for consilience." Neuropsychopharmacology, 46(10), 1715-1723. https://doi.org/10.1038/s41386-020-00950-y ; Lewis, M. (2018). "Brain change in addiction as learning, not disease." New England Journal of Medicine, 379(16), 1551-1560. https://doi.org/10.1056/NEJMra1602872
  2. 13.Desai, D., Patel, J., Saiyed, F., Upadhyay, H., et al. (2024). "A literature review on holistic well-being and dopamine fasting: an integrated approach." Cureus, 16(6), e61643. https://doi.org/10.7759/cureus.61643 ; Lembke, A. (2021). Dopamine Nation: Finding Balance in the Age of Indulgence. Dutton. (30 days of abstinence from a compulsively used substance or behavior.)
  3. 14.Alexander, B.K., Coambs, R.B., and Hadaway, P.F. (1978). "The effect of housing and gender on morphine self-administration in rats." Psychopharmacology, 58(2), 175-179. https://doi.org/10.1007/bf00426903 ; Gage, S.H., and Sumnall, H.R. (2019). "Rat Park: how a rat paradise changed the narrative of addiction." Addiction, 114(5), 917-922. https://doi.org/10.1111/add.14481 ; Petrie, B.F. (1996). "Environment is not the most important variable in determining oral morphine consumption in Wistar rats." Psychological Reports, 78(2), 391-400. https://doi.org/10.2466/pr0.1996.78.2.391 ; Bozarth, M.A., Murray, A., and Wise, R.A. (1989). "Influence of housing conditions on the acquisition of intravenous heroin and cocaine self-administration in rats." Pharmacology Biochemistry and Behavior, 33(4), 903-907. https://doi.org/10.1016/0091-3057(89)90490-5 ; Venniro, M., Zhang, M., Caprioli, D., Hoots, J.K., et al. (2018). "Volitional social interaction prevents drug addiction in rat models." Nature Neuroscience, 21(11), 1520-1529. https://doi.org/10.1038/s41593-018-0246-6 (the first Rat Park study used 32 rats, and intake was measured by weighing bottles in cages but counting drops in the park.)
  4. 31.Hendershot, C.S., Bremmer, M.P., Paladino, M.B., Kostantinis, G., et al. (2025). "Once-weekly semaglutide in adults with alcohol use disorder: a randomized clinical trial." JAMA Psychiatry, 82(4), 395-405. https://doi.org/10.1001/jamapsychiatry.2024.4789 ; Klausen, M.K., Justesen, S.K., Pedersen, J.N., Rasmussen, L., et al. (2026). "Once-weekly semaglutide versus placebo in patients with alcohol use disorder and comorbid obesity: a randomised, double-blind, placebo-controlled trial." The Lancet, 407(10540), 1687-1698. https://doi.org/10.1016/S0140-6736(26)00305-3 ; Schacht, J.P., Sakai, J.T., Raymond, K., and Shelton, R. (2026). "Oral semaglutide for alcohol use disorder: a randomized clinical trial." American Journal of Psychiatry, 183(9), 636-645. https://doi.org/10.1176/appi.ajp.20260003 (heavy drinking days or drinks per drinking day fell in each trial; overall drinks per day did not change in the two smaller trials, one of which missed its primary outcome.) ; National Institute on Alcohol Abuse and Alcoholism. Understanding Alcohol Use Disorder. https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/understanding-alcohol-use-disorder ; 988 Suicide and Crisis Lifeline. https://988lifeline.org

Every work this chapter cites

The chapter's 32 notes cite 75 works, listed by note number. Each is also in the full source register.

  1. 1.Robins, L.N., Davis, D.H., and Nurco, D.N (1974). How permanent was Vietnam drug addiction? American Journal of Public Health. 10.2105/ajph.64.12_suppl.38Robins, L.N., Helzer, J.E., and Davis, D.H (1975). Narcotic use in southeast Asia and afterward: an interview study of 898 Vietnam returnees. Archives of General Psychiatry. 10.1001/archpsyc.1975.01760260019001Robins, L.N (1993). Vietnam veterans' rapid recovery from heroin addiction: a fluke or normal expectation? Addiction. 10.1111/j.1360-0443.1993.tb02123.x
  2. 2.Berridge, K.C., and Robinson, T.E (1998). What is the role of dopamine in reward: hedonic impact, reward learning, or incentive salience? Brain Research Reviews. 10.1016/s0165-0173(98Robinson, T.E., and Berridge, K.C (1993). The neural basis of drug craving: an incentive-sensitization theory of addiction. Brain Research Reviews. 10.1016/0165-0173(93
  3. 3.Schultz, W (2016). Dopamine reward prediction error coding. Dialogues in Clinical Neuroscience. 10.31887/DCNS.2016.18.1/wschultzNesse, R.M., and Berridge, K.C (1997). Psychoactive drug use in evolutionary perspective. Science. 10.1126/science.278.5335.63
  4. 4.Sullivan, R.J., and Hagen, E.H (2002). Psychotropic substance-seeking: evolutionary pathology or adaptation? Addiction. 10.1046/j.1360-0443.2002.00024.xHagen, E.H., Sullivan, R.J., Schmidt, R., Morris, G., et al (2009). Ecology and neurobiology of toxin avoidance and the paradox of drug reward. Neuroscience. 10.1016/j.neuroscience.2009.01.077
  5. 5.Substance Abuse and Mental Health Services Administration (2026). Key Substance Use and Mental Health Indicators in the United States: Results from the 2025 National Survey on Drug Use and Health. samhsa.govWorld Health Organization (2024). Over 3 million annual deaths due to alcohol and drug use, majority among men. who.int
  6. 6.Kelly, J.F., Bergman, B., Hoeppner, B.B., Vilsaint, C., and White, W.L (2017). Prevalence and pathways of recovery from drug and alcohol problems in the United States population: implications for practice, research, and policy. Drug and Alcohol Dependence. 10.1016/j.drugalcdep.2017.09.028
  7. 7.Jonas, D.E., Amick, H.R., Feltner, C., Bobashev, G., et al (2014). Pharmacotherapy for adults with alcohol use disorders in outpatient settings: a systematic review and meta-analysis. JAMA. 10.1001/jama.2014.3628
  8. 8.Sordo, L., Barrio, G., Bravo, M.J., Indave, B.I., et al (2017). Mortality risk during and after opioid substitution treatment: systematic review and meta-analysis of cohort studies. BMJ. 10.1136/bmj.j1550
  9. 9.National Center for Health Statistics (2026). U.S. overdose deaths decrease for third consecutive year in 2025. cdc.govDrug Enforcement Administration, Diversion Control Division. deadiversion.usdoj.gov
  10. 10.Kelly, J.F., Humphreys, K., and Ferri, M (2020). Alcoholics Anonymous and other 12-step programs for alcohol use disorder. Cochrane Database of Systematic Reviews. 10.1002/14651858.CD012880.pub2
  11. 11.Bolívar, H.A., Klemperer, E.M., Coleman, S.R.M., DeSarno, M., et al (2021). Contingency management for patients receiving medication for opioid use disorder: a systematic review and meta-analysis. JAMA Psychiatry. 10.1001/jamapsychiatry.2021.1969Notley, C., Gentry, S., Livingstone-Banks, J., Bauld, L., et al (2025). Incentives for smoking cessation. Cochrane Database of Systematic Reviews. 10.1002/14651858.CD004307.pub7
  12. 12.Yeola, A., Allen, M.R., Desai, N., Poliak, A., et al (2025). Growing health concern regarding gambling addiction in the age of sportsbooks. JAMA Internal Medicine. 10.1001/jamainternmed.2024.8193Forrest, R., Doan, N., MacDonald-Spracklin, R., Pugliese, M., et al (2026). Emergency department visits for gambling disorders after the legalization of single-event sports betting and rapid expansion of online gambling. American Journal of Preventive Medicine. 10.1016/j.amepre.2026.108551Xu, T., Grubbs, J.B., and Kraus, S.W (2025). A longitudinal investigation of sports betting legalization's influence on problem gambling. Addictive Behaviors. 10.1016/j.addbeh.2025.108448Sung, H., Jiang, C., Bandi, P., Minihan, A., et al (2024). Differences in cancer rates among adults born between 1920 and 1990 in the USA: an analysis of population-based cancer registry data. The Lancet Public Health. 10.1016/S2468-2667(24
  13. 13.Desai, D., Patel, J., Saiyed, F., Upadhyay, H., et al (2024). A literature review on holistic well-being and dopamine fasting: an integrated approach. Cureus. 10.7759/cureus.61643Lembke, A (2021). Dopamine Nation: Finding Balance in the Age of Indulgence.
  14. 14.Alexander, B.K., Coambs, R.B., and Hadaway, P.F (1978). The effect of housing and gender on morphine self-administration in rats. Psychopharmacology. 10.1007/bf00426903Gage, S.H., and Sumnall, H.R (2019). Rat Park: how a rat paradise changed the narrative of addiction. Addiction. 10.1111/add.14481Petrie, B.F (1996). Environment is not the most important variable in determining oral morphine consumption in Wistar rats. Psychological Reports. 10.2466/pr0.1996.78.2.391Bozarth, M.A., Murray, A., and Wise, R.A (1989). Influence of housing conditions on the acquisition of intravenous heroin and cocaine self-administration in rats. Pharmacology Biochemistry and Behavior. 10.1016/0091-3057(89Venniro, M., Zhang, M., Caprioli, D., Hoots, J.K., et al (2018). Volitional social interaction prevents drug addiction in rat models. Nature Neuroscience. 10.1038/s41593-018-0246-6
  15. 15.Schacht, R., and Kramer, K.L (2019). Are We Monogamous? A Review of the Evolution of Pair-Bonding in Humans and Its Contemporary Variation Cross-Culturally. Frontiers in Ecology and Evolution. 10.3389/fevo.2019.00230
  16. 16.Robles, T.F., Slatcher, R.B., Trombello, J.M., and McGinn, M.M (2014). Marital quality and health: A meta-analytic review. Psychological Bulletin. 10.1037/a0031859Holt-Lunstad, J., Birmingham, W., and Jones, B.Q (2008). Is there something unique about marriage? The relative impact of marital status, relationship quality, and network social support on ambulatory blood pressure and mental health. Annals of Behavioral Medicine. 10.1007/s12160-008-9018-yKiecolt-Glaser, J.K., Loving, T.J., Stowell, J.R., Malarkey, W.B., et al (2005). Hostile marital interactions, proinflammatory cytokine production, and wound healing. Archives of General Psychiatry. 10.1001/archpsyc.62.12.1377Kiecolt-Glaser, J.K., and Newton, T.L (2001). Marriage and health: His and hers. Psychological Bulletin. 10.1037/0033-2909.127.4.472Kiecolt-Glaser, J.K., and Wilson, S.J (2017). Lovesick: How Couples' Relationships Influence Health. Annual Review of Clinical Psychology. 10.1146/annurev-clinpsy-032816-045111
  17. 17.Twenge, J.M., Sherman, R.A., and Wells, B.E (2017). Declines in Sexual Frequency among American Adults, 1989-2014. Archives of Sexual Behavior. 10.1007/s10508-017-0953-1Ueda, P., Mercer, C.H., Ghaznavi, C., and Herbenick, D (2020). Trends in Frequency of Sexual Activity and Number of Sexual Partners Among Adults Aged 18 to 44 Years in the US, 2000-2018. JAMA Network Open. 10.1001/jamanetworkopen.2020.3833
  18. 18.Muise, A., Schimmack, U., and Impett, E.A (2016). Sexual Frequency Predicts Greater Well-Being, But More is Not Always Better. Social Psychological and Personality Science. 10.1177/1948550615616462Lindau, S.T., Schumm, L.P., Laumann, E.O., Levinson, W., et al (2007). A Study of Sexuality and Health among Older Adults in the United States. New England Journal of Medicine. 10.1056/NEJMoa067423
  19. 19.Roddy, M.K., Walsh, L.M., Rothman, K., Hatch, S.G., et al (2020). Meta-analysis of couple therapy: Effects across outcomes, designs, timeframes, and other moderators. Journal of Consulting and Clinical Psychology. 10.1037/ccp0000514Doss, B.D., Cicila, L.N., Georgia, E.J., Roddy, M.K., et al (2016). A randomized controlled trial of the web-based OurRelationship program: Effects on relationship and individual functioning. Journal of Consulting and Clinical Psychology. 10.1037/ccp0000063Hawkins, A.J., Blanchard, V.L., Baldwin, S.A., and Fawcett, E.B (2008). Does marriage and relationship education work? A meta-analytic study. Journal of Consulting and Clinical Psychology. 10.1037/a0012584Stanley, S.M., Rhoades, G.K., Loew, B.A., Allen, E.S., et al (2014). A Randomized Controlled Trial of Relationship Education in the U.S. Army: 2-Year Outcomes. Family Relations. 10.1111/fare.12083
  20. 20.Moon, J.R., Kondo, N., Glymour, M.M., and Subramanian, S.V (2011). Widowhood and Mortality: A Meta-Analysis. PLoS ONE. 10.1371/journal.pone.0023465Elwert, F., and Christakis, N.A (2008). The Effect of Widowhood on Mortality by the Causes of Death of Both Spouses. American Journal of Public Health. 10.2105/AJPH.2007.114348Mostofsky, E., Maclure, M., Sherwood, J.B., Tofler, G.H., et al (2012). Risk of Acute Myocardial Infarction After the Death of a Significant Person in One's Life: The Determinants of Myocardial Infarction Onset Study. Circulation. 10.1161/CIRCULATIONAHA.111.061770
  21. 21.Stroebe, M., Schut, H., and Stroebe, W (2007). Health outcomes of bereavement. The Lancet. 10.1016/S0140-6736(07Bonanno, G.A., Wortman, C.B., Lehman, D.R., Tweed, R.G., et al (2002). Resilience to loss and chronic grief: A prospective study from preloss to 18-months postloss. Journal of Personality and Social Psychology. 10.1037/0022-3514.83.5.1150Infurna, F.J., and Luthar, S.S (2016). Resilience to Major Life Stressors Is Not as Common as Thought. Perspectives on Psychological Science. 10.1177/1745691615621271
  22. 22.Lundorff, M., Holmgren, H., Zachariae, R., Farver-Vestergaard, I., et al (2017). Prevalence of prolonged grief disorder in adult bereavement: A systematic review and meta-analysis. Journal of Affective Disorders. 10.1016/j.jad.2017.01.030American Psychiatric Association. psychiatry.orgEisma, M.C (2023). Prolonged grief disorder in ICD-11 and DSM-5-TR: Challenges and controversies. Australian and New Zealand Journal of Psychiatry. 10.1177/00048674231154206
  23. 23.Shear, K., Frank, E., Houck, P.R., and Reynolds, C.F (2005). Treatment of Complicated Grief: A Randomized Controlled Trial. JAMA. 10.1001/jama.293.21.2601Shear, M.K., Wang, Y., Skritskaya, N., Duan, N., et al (2014). Treatment of Complicated Grief in Elderly Persons: A Randomized Clinical Trial. JAMA Psychiatry. 10.1001/jamapsychiatry.2014.1242Shear, M.K., Reynolds, C.F., Simon, N.M., Zisook, S., et al (2016). Optimizing Treatment of Complicated Grief: A Randomized Clinical Trial. JAMA Psychiatry. 10.1001/jamapsychiatry.2016.0892Johannsen, M., Damholdt, M.F., Zachariae, R., Lundorff, M., et al (2019). Psychological interventions for grief in adults: A systematic review and meta-analysis of randomized controlled trials. Journal of Affective Disorders. 10.1016/j.jad.2019.04.065
  24. 24.Norton, M.I., and Gino, F (2014). Rituals alleviate grieving for loved ones, lovers, and lotteries. Journal of Experimental Psychology: General. 10.1037/a0031772
  25. 25.Cohen, R., Bavishi, C., and Rozanski, A (2016). Purpose in Life and Its Relationship to All-Cause Mortality and Cardiovascular Events: A Meta-Analysis. Psychosomatic Medicine. 10.1097/PSY.0000000000000274Alimujiang, A., Wiensch, A., Boss, J., Fleischer, N.L., et al (2019). Association Between Life Purpose and Mortality Among US Adults Older Than 50 Years. JAMA Network Open. 10.1001/jamanetworkopen.2019.4270Hill, P.L., and Turiano, N.A (2014). Purpose in Life as a Predictor of Mortality Across Adulthood. Psychological Science. 10.1177/0956797614531799
  26. 26.Sone, T., Nakaya, N., Ohmori, K., Shimazu, T., et al (2008). Sense of Life Worth Living (Ikigai) and Mortality in Japan: Ohsaki Study. Psychosomatic Medicine. 10.1097/PSY.0b013e31817e7e64
  27. 27.Kim, E.S., Strecher, V.J., and Ryff, C.D (2014). Purpose in life and use of preventive health care services. Proceedings of the National Academy of Sciences. 10.1073/pnas.1414826111Boyle, P.A., Buchman, A.S., Barnes, L.L., and Bennett, D.A (2010). Effect of a Purpose in Life on Risk of Incident Alzheimer Disease and Mild Cognitive Impairment in Community-Dwelling Older Persons. Archives of General Psychiatry. 10.1001/archgenpsychiatry.2009.208
  28. 28.Okun, M.A., Yeung, E.W., and Brown, S (2013). Volunteering by older adults and risk of mortality: A meta-analysis. Psychology and Aging. 10.1037/a0031519Kim, E.S., Whillans, A.V., Lee, M.T., Chen, Y., et al (2020). Volunteering and Subsequent Health and Well-Being in Older Adults: An Outcome-Wide Longitudinal Approach. American Journal of Preventive Medicine. 10.1016/j.amepre.2020.03.004
  29. 29.Li, S., Stampfer, M.J., Williams, D.R., and VanderWeele, T.J (2016). Association of Religious Service Attendance With Mortality Among Women. JAMA Internal Medicine. 10.1001/jamainternmed.2016.1615
  30. 30.Sturm, V.E., Datta, S., Roy, A.R.K., Sible, I.J., et al (2022). Big smile, small self: Awe walks promote prosocial positive emotions in older adults. Emotion. 10.1037/emo0000876
  31. 31.Hendershot, C.S., Bremmer, M.P., Paladino, M.B., Kostantinis, G., et al (2025). Once-weekly semaglutide in adults with alcohol use disorder: a randomized clinical trial. JAMA Psychiatry. 10.1001/jamapsychiatry.2024.4789Morgan, W.J., Mauger, D.T., Bacharier, L.B., Bauer, C.S., et al (2026). Use of the bacterial lysate OM-85 for the primary prevention of wheezing lower respiratory illness in preschool children: a randomised, placebo-controlled trial. The Lancet. 10.1016/S0140-6736(26Schacht, J.P., Sakai, J.T., Raymond, K., and Shelton, R (2026). Oral semaglutide for alcohol use disorder: a randomized clinical trial. American Journal of Psychiatry. 10.1176/appi.ajp.20260003National Institute on Alcohol Abuse and Alcoholism. niaaa.nih.gov988 Suicide and Crisis Lifeline. 988lifeline.org
  32. 32.Heilig, M., MacKillop, J., Martinez, D., Rehm, J., et al (2021). Addiction as a brain disease revised: why it still matters, and the need for consilience. Neuropsychopharmacology. 10.1038/s41386-020-00950-yLewis, M (2018). Brain change in addiction as learning, not disease. New England Journal of Medicine. 10.1056/NEJMra1602872

The full source register

This page carries the chapter's apparatus. The chapter itself, and the fifteen others, are in the book.

Get the bookThe 30-day protocolAll sixteen chapters