The hypothesis, and how to falsify it

The main hypothesis

In people with addiction, the need that follows last use differs not only in intensity but in shape over time: speed of rise, time to maximum, and above all the share that never returns to baseline.

The guiding idea is that the important difference lies in the tail, not the peak. Those who relapse do not necessarily react more strongly: they return more slowly, or do not return at all.

How to measure need without asking for it

Not with the question "how bad is it", but with the price a person will pay to make the discomfort stop: how much work, how much waiting, how much forgoing. It is a behaviour, it has a unit, and it can be repeated days apart.

Alongside it we record the physiological signature of the state, and separately we collect reported discomfort. Three distinct quantities, never merged into a single score.

The interesting observation is not that all three run high. It is that they may come apart: the price rises more than the measured discomfort would justify.

What would falsify it

The project stops, and says so, if any of the following happens.

• The parameters are not stable. Measured twice weeks apart, the same person produces different curves. Below the pre-specified preliminary threshold of 0.70, the parameter is not sufficiently stable for the intended use.
• They add nothing. The parameters do not improve prediction of outcome beyond what is already in the clinical record.
• They measure the substance, not the person. The differences are fully explained by current medication, days since admission, or comorbidity.

Each of these outcomes is publishable. None of them is a failure of the method: they are answers.

An extension, not a promise

Different substances produce different and non-interchangeable physical withdrawal: the tremor of alcohol withdrawal bears no resemblance to the flattening that follows stimulants. On that level there is no convergence, and we do not claim any.

The hypothesis concerns a different layer: discomfort, urgency, narrowing of attention. There a common shape is plausible.

It is verified in one way only: the same protocol on a second substance, then a check on whether the structure of the parameters holds and whether a model built on the first works on the second. If it holds, convergence is demonstrated with a number. If it does not, two substance-specific instruments remain. No outcome wipes out the work.

Two cautions we keep in writing

Temporal succession is not a causal chain. If sleep worsens before the physiological response, and that precedes use, we have a lead, not a cause. A third factor we are not measuring may be at work.

A sensor that detects exposure to a substance does not detect loss of control. It documents an event, within its own limits. The meaning of that event requires something else.