Amid A 'Failed War On Drugs,' The Latest Thinking On Addiction

WBUR's Deborah Becker
WBUR's Deborah Becker

WBUR reporter and news host Deborah Becker is just back from a workshop on the latest information and science about addiction. The workshop took on added importance amid the recent (and now global) declarations that the American "war on drugs" has been a total failure, leaving us with millions of damaged young people and their families plus staggering incarceration costs. Here, she shares what she learned:

During the Addiction Studies Program for Journalists sponsored by Wake Forest University School of Medicine and National Families in Action, the researchers admitted that there’s still a lot they don’t know, but they said they’re confident, if not adamant, about several things. Among them: They say addiction is a chronic disease of the brain for which there is no cure; they distinguish between addiction and physical dependence; and they say the parents of adolescent boys should be very worried.[module align="right" width="half" type="pull-quote"]

Unintentional overdose deaths from prescription drugs in the U.S. increased by more than 100% in 2008

[/module]These are just some of the staggering statistics:

More than 21 million people in the U.S. meet the criteria for needing treatment for a drug or alcohol problem and only about one million people actually think they need it.

In 16 states, including Massachusetts, drug overdose deaths now top car crashes as the number one cause of accidental deaths. In fact, unintentional overdose deaths from prescription drugs in the U.S. increased by more than 100% in 2008.

51% of all drug users are under 21 years old, with most cannabis use disorders first diagnosed in those between 15 and 19 years old.

It’s clear that we have a problem and it’s always helpful to clearly define a problem before trying to solve it — so how do these researchers define addiction? In trying to sum up two days of presentations and hoping not to grossly oversimplify, I would say the researchers define addiction as “the compulsive use of a drug even in the face of negative consequences.”

They debunk the stereotype of the addict who physically must have the substance or go through wrenching withdrawal. Although the researchers say physical dependence does precede addiction and helps maintain it, they say there also must be a psychological dependence – so the drug becomes central to a person’s life and replaces most everything else. In other words: someone is an addict when he or she considers drug-taking necessary for their well being above all else.

Virginia Guardsman disposes of tons of prescription drugs
Virginia Guardsman disposes of tons of prescription drugs

The neuroscience is fascinating, but after the decades of destruction from all kinds of addiction – drugs, alcohol, tobacco, gambling — you would think we would, well, have it down to more of a science.

These researchers say the complexity of brain science, the many types of addictions and the shame and stigma have all helped to stymie their work. But the public is starting to speak up and demand better – namely addicts, their loved ones and their treatment providers.

So in the past five years, there have been discoveries which the workshop scientists say show that addiction is a disease of the brain. They showed us studies indicating significant differences in addicts’ brains compared with the brains of non-addicts. Some treatment providers explained how they’re now scanning addicts’ brains, with the scans suggesting that the addicts’ brains are biologically more prone to compulsive substance use. These scientists put addiction in the same category as other chronic diseases such as adult-onset diabetes and hypertension. They say that just like diabetes treatment, addiction treatment won’t work unless a patient makes lifestyle changes as well.

Addiction can also be hereditary, according to the researchers. They cite adoption studies showing that children of alcoholic parents are likely to become alcoholics – even if they’re raised by non-alcoholics. Genetic factors, they say, account for 50-80% of the risk of addiction and the influence of addiction can go back more than one generation.

Perhaps the most disturbing information presented at the workshop involved adolescents. It’s no surprise that most drug use begins during the teen years and a main reason why is because the brain's prefrontal cortex is still developing. This part of the brain basically helps someone think before doing something stupid. The science is now confirming what car rental companies have known for a long time – that self-control (the prefrontal cortex) is not fully developed until about age 25. This is why many of these companies don’t usually rent cars to those under 25.

The public policy ramifications of addiction are enormous. We now know that all of us are paying for the millions of untreated substance abusers who are caught in an ever-revolving cycle of incarceration because of the “war on drugs.” But there isn’t a lot of solid evidence about what we should do instead. We don’t really know which treatment works best for which users, but we do know that a majority of addicts resist treatment or relapse.

One of the presenters, Doug Marlowe, from the Treatment Research Institute at the University of Pennsylvania, is proposing what he calls “evidence-based sentencing.” He maintains that the courts should consider whether a prison sentence will cost more than its worth, and whether it will help make an offender a more productive member of society. Marlowe believes that when sentencing, judges should publicly state the cost and effectiveness of a sentence to show that the court system is working toward trying to prevent inmates from reoffending and not just punishing without regard what happens after that.

Using science to help inform public policy must continue in order to successfully address the growing problem of drug abuse and addiction-- which, unfortunately, will continue to be among the big news stories of our time.

This program aired on June 20, 2011. The audio for this program is not available.

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Carey Goldberg Editor, CommonHealth
Carey Goldberg is the editor of WBUR's CommonHealth section.



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