Addiction is both a personal health crisis and a public health concern; it wreaks havoc on individual lives and can damage entire communities. The opioid crisis, for example, has led to the deaths of thousands of people, devastated families, and left cities and towns struggling financially from the loss of a workforce. How we understand addiction, therefore, has significant policy implications. The trouble is, addiction is difficult to treat, relapse is common, and there is no scientific rule to explain why any given drinker, user of prescription drugs, or recreational marijuana user becomes dependent or addicted.
While the opioid crisis is certainly unprecedented in death toll, Americans have been seeking public policy answers to the sociological problems wrought by drugs for decades. Starting in the second half of the 20th century, American drug policy became increasingly punitive and focused on enforcement; coined “the war on drugs” by the press after President Nixon declared drugs to be “public enemy number one.” Federal anti-drug dollars for law enforcement and interdiction grew throughout the 1970s, and by 1980 more money was being spent on enforcement than treatment, education, and prevention.
Heavy-handed enforcement and complete prohibition (except for alcohol which is a topic for another article) was fueled by the belief that drugs have such a powerful physiological effect on the brain that drug use results in a permanently warped brain. Infamously, the war on drugs has resulted in 500,000 Americans incarcerated on drug offenses. It was successful at locking people up but not successful at reducing drug use. Even before the height of the opioid crisis, the number of deaths due to drugs doubled from 1993 to 2013, as other causes of death have declined. The war on drugs has been widely critiqued for taking a too simple, albeit hardline, approach to drug addiction. The deterrent effect of harsh prison sentences wasn’t enough to prevent new addictions or dissuade use. In response to this failure and desperate for a solution to a growing problem, some believe they have “discovered” the cause of addiction. In 2015, Chasing the Scream: The First and Last Days of the War on Drugs by Johann Hari maintained best-seller status for weeks. Hari’s theory is that the war on drugs was not successful in reducing drug dependency in the United States because it did not address the true cause of addiction: a lack of human connection. The book was followed by a Ted Talk, the modern mode of sharing novel, uncompromising ideas which are easily summed up in a marketable catch phrase but are rarely nuanced.
Hari’s theory was based on studies conducted at Simon Fraser University by a researcher named Bruce Alexander. Alexander studied the relationship between environment and addiction and hypothesized that drug addiction was not the result of changes in brain chemistry but a behavioral reaction to negative environments. Through a series of experiments involving fostering drug dependency in rats, Alexander recorded that rats he had raised in an isolated environment without stimuli such as toys, other rats, and the opportunity to breed consumed significantly more drugs than rats he had raised in a group with toys and allowed to breed. They, he found, decreased their drug use when given a choice. Alexander argued that the Rat Park residents, as he called the rats raised in a group setting, were able to overcome any dependency they had formed because their environment fostered other feel-good behaviors and that withdrawal was not all that physically taxing.
He described the rats’ withdrawal as “some minor withdrawal signs, twitching, what have you, but there were none of the mythic seizures and sweats.” This and other similar experiments led Alexander to claim that drugs do not have physiological, innately addictive effects that cannot be resisted under the correct conditions. In a paper submitted to the Canadian Senate arguing for the legalization of drugs, he even went as far as to claim that “normal people can ignore heroin … even when it is plentiful in their environment, and they can use these drugs with little likelihood of addiction.”
But there are some crucial problems with his study. Science and Nature, two major peer-reviewed science journals rejected Alexander’s first paper on his Rat Park, probably due to methodological errors. For instance, in one experimental condition the sample size was very small; only 16 rats for each environment. Given that rats aren’t required to give knowing consent to participate in a research study and are easy to come by, the sample size should have been much, much higher. Subsequent studies duplicated the Rat Park research design and had mixed results.
Even if the research was scientifically sound, the conclusion is way overblown. Rat Park is not a reflection of human social conditions. Every person faces stress, holds ambitions, experiences disappointments, is lonely once in a while, and yet not every person suffers from a substance-use disorder. The relationship between these common emotions and other factors like mental health disorders, trauma, resiliency, culture, personality, and addiction is only understood at the surface level. For example, we know that people with mood or anxiety disorders are two times more likely to have a substance-use disorder, but we cannot predict if any given person with a mental health problem will become addicted or pinpoint exactly what factors protected them from addiction.
Also, Alexander’s claim that exposure to drugs is not dangerous because “normal people” can resist any addictive qualities cannot be substantiated with actual evidence. After several US states adjusted their policies regarding marijuana use, researchers are now attempting to discover whether these changes led to increased use and dependency. The jury is still out. An early study in this investigation by the RAND Corporation found that laws that legalized the establishment of medical marijuana dispensaries directly correlate with increases in overall pot use and dependence. A later report only found an increase in marijuana use only among those who also reported heavy alcohol use. And no one can say for certain whether these correlations are directly related or if they reflect social attitudes independent of the law.
Most importantly, withdrawal symptoms are real and painful. To avoid withdrawal for even certain prescription drugs requires planning by a doctor.
Alexander wasn’t wrong to focus his attention on environmental factors and social connections, both are important influences in the development of addiction, but they aren’t the sole cause. Similarly, the innate chemical properties of various drugs are not the sole cause of addiction, as the architects of the war on drugs believed. In seeking solutions, it is tempting to look for the Rosetta Stone, the one piece that will unlock all knowledge. There is no silver public policy bullet that will solve the opioid crisis, as recent studies have shown, or drug addiction generally. This is why we must examine addiction as a complex problem and pursue nuanced, multifaceted approaches to address the crisis.
The drug court model is one such approach, though on a micro-scale. Drug courts view addiction as a complex disorder and treat it using many tools—supervision, positive and negative behavior reinforcement, and therapy—in an environment that fosters respect and human dignity. Drug court teams build individualized treatment plans that are tailored to the unique needs of each drug court program participant. They consider, among other things, the participant’s social connections, education level, and culture when developing these plans. And when any given approach fails to change a person’s relationship with drugs, the drug court team revises the treatment plan and attempts a different method.
It is time our policymakers attempt a different method to treating this public health crisis. Addiction is complicated and messy, people are complicated and messy, and we need to ask hard questions and examine many, many different approaches. The drug court model is a good place to start looking at how that is done.
Megan Ward is a Program Associate at the Justice Programs Office.