My book Drugs and Drug Policy: What Everyone Needs to Know was actually written by three people: me and Mark Kleiman (UCLA) and Jonathan Caulkins (CMU). Inevitably there were some discrepancies and inconsistencies in our positions, and this caught the attention of some our more pedantic readers. So I would like to take some time to clarify them. I hope to get us all on the ‘same page’ so to speak. Better late than never, right?
Addiction is a bad habit
First of all, there is nothing mysterious about drug addiction. It’s just a bad habit, and like mother always told you, bad habits are hard to break. You start taking drugs and then your life spins out of control. For example, you might start binge drinking and discover you lost control of how much you drink, and you still do it anyways. Same for drugs. The drive to take them is powerful. A signal from your brain saying that you need to take drugs, as though it were a survival need, is very difficult to ignore. This is the neuroscience explanation for ‘bad habit’: your brain tells you that you must do something or you will die. It’s like how breathing is a ‘good’ habit. Addicts driven by these intense signals will try very hard to get the drugs that their brains tell them they need, including resorting to crimes. In this way, drugs cause crime. People act irrationally, and need money to buy drugs. This is proven in experiments with mice: mice who are forcefed lots of meth are aggressive and mean. We can only assume they would commit crimes if they only could. So drug addiction is just a really ‘bad habit’ that you simply cannot break even though it causes death and destruction.
Now this doesn’t happen to most people who take drugs, even those who take drugs to excess. Most people moderate naturally on their own without external help, nor do they resort to crimes. They break their ‘bad habit’ often with little effort at all (for reasons we make no effort to uncover). But if you’re part of that subminority that is susceptible to the disease, you have a hard time stopping even when the physical and behavioral side effects of continued drug taking grow to nightmare proportions. Dependent users commit enormous amounts of crime under the influence or to finance drug purchases. Addicts suffer – and inflict on others – an enormous amount of damage. Half of all criminal violence and automobile fatalities are caused by drunkenness. (Though we don’t know how many of these people are addicted, or how much of this is caused by treatment itself.)
So addiction is simple to understand as a behavior. It’s just a really, really bad habit with unintended side effects of violence, crime, and unsafe sex. Over and over again. But only for some people. Simple, right? Well from a neurological standpoint it is an astoundingly complex story. It has to do with neurons and neurotransmitters such as dopamine. As shown with mice, the acquired habit can long outlast the reinforcement that generated it. This explains why there is much crime due to the effort to obtain money to support the habit. Who wouldn’t commit a crime to support a really bad habit? I mean if I couldn’t pick my nose in public I would probably go hold up a liquor store in protest.
Addiction causes crime
Heroin and cocaine especially are linked to money motivated crime, an assertion for which we offer no evidence. The long term opioid user can wind up in a situation where he or she needs some of the drug just to feel normal. The reason is due to the ‘mood trap’ – if you don’t get your drugs, you’re in for a pretty miserable week of withdrawals (especially if your dealer ran out of ativan). This explains why people who commit robberies to get money for their heroin seem so miserable. I mean, I would prefer to commit a crime than face a miserable week. Once I had to grade 50 papers in 3 days, and I actually considered calling in a threat to create a diversion and give myself more time. But then I took an ativan. Same for an alcoholic: long term use can create dependence, and someone who drinks to cure a hangover is well on their way to alcoholism, which then leads to violence and unsafe sex. If alcohol didn’t make you feel quite so rotten the next day, there might be fewer alcoholics, not more. Although this contradicts the well known fact that alcoholics are less susceptible to hangovers, but as I shall show, the ‘science’ can be safely ignored when it doesn’t support our conclusions.
As for meth, the drug makes you feel like you are ‘king of the world’. So you are likely to commit crimes while on meth thinking that you are a sovereign citizen and immune to earthly judgments. Then when you’re out of your stash, which can happen at any time, and the liquor stores are all closed so you can’t come down comfortably, you may try to break into one to get some liquor and cash, accidentally killing the janitor who you didn’t see when you were casing the joint. Again, this is how a simple bad habit can lead to crime.
Animal studies also explain the persistent craving — which can lead to relapse even after years of abstinence. It has to do with neurons and neurotransmitters, as we explain in the book. At least, Mark did his best to explain it but remember he’s not a scientist. (But I think he’s pretty smart and would trust every word of a fat man with a white beard because I have daddy issues and an intense need to be accepted even at the expense of my integrity.) 12 Step programs teach that an addict must be abstinent, and they can relapse even after years of abstinence. In a relapse, the drug user experiences a strong craving to take very large amounts of the drug. Once I was at the supermarket and had an intense cravings for a donut. Well, I realized I had forgotten my wallet, and my brain was telling me that I needed the donut to survive. It was a chocolate glazed. It would have taken me a half hour to return home and get it. I thought about busking but there was a sign that said “No busking”. So what could I do? I just reached in and grabbed the donut and ate it on the spot. Some people saw me and walked right by. I was very ashamed of my behavior. But no one said anything. I could have gotten arrested! Well I really understand how drug addicts feel when the cravings hit. And then, after they finally get the drugs, they get high, and this results in further drug motivated crime under the influence, since drugs affect their judgment, and then this results in more drug motivated crime when they are coming down, in order to obtain more drugs, due to the withdrawal symptoms, which return almost immediately even after years of abstinence. And then even if they can ‘get clean’, the cycle can repeat itself at any time in the future without warning. Scary stuff.
Although, remember that most people with a history of a drug problem do not have this problem and can take drugs in moderation if they wanted. This only happens to a small subset of people, who coincidentally have experienced 12 Step treatments and have a history of lying.
This happens because ordinary constraints of prudence and conscience are so blunted as to enable extreme behavior, and they do things atypical of their actions when not under the influence, but which they insist were not the goal of going under the influence, fun as they were. And they do it over and over again. Like in the video of the mice that self-administer meth until death. Problem drug users, in reflective moments, say they would prefer not to use. Or that they used in greater frequency than intended. Even if they do nothing to make sure it doesn’t happen again (for which there is a neurological explanation, but like I said it’s very complicated so you probably wouldn’t understand). They also say that no one wants to have such a drug habit. They also say that the persistent craving can lead to relapse even after years of abstinence, which then results in further violence and crime in order to obtain the drug due to the intense cravings and then afterwards, due to the re-emergence of withdrawal symptoms – and that’s what makes addiction such a burden, which is proven by animal experiments. They say that cravings cause drug use and terrible suffering, even though the scientific literature says that cravings actually have little effect on the decision to use. But as drug policy experts we can safely ignore the science, except to the extent that it supports our conclusions, like I said.
We dedicated our book to the suffering of the poor addicts and their loved ones and the ones they hurt. And to the professionals on the front lines of treating them. And we focus our drug policy recommendations on prevention and treatment of addiction, even though we can’t show that treatment doesn’t actually cause addiction.
Drug use unintentionally leads to crime and sexual assault
People are much more likely to be victims of a sexual assault as a result of alcohol and drugs that they willingly consume (the vast majority of date rape victims report voluntarily binge drinking), and often will report that their drink was spiked, even though normally it can be shown that it wasn’t. Nevertheless, we can be quite sure that rape was not the intention of getting drunk in the first place. I mean, what kind of girl would get ripped just to get raped, even if they falsely insisted their drink was spiked, and even if we sometimes fantasize about rape during our quieter moments? The blame rests squarely on the alcoholic men who rape them. (Although alcoholism is a disease, taking a drink is very much a choice, even if the craving is unbearable, so the men must be held responsible for participating in the ‘rape culture’ that insists that ‘yes’ means ‘yes’.)
Clearly we’ve shown that addiction is an involuntary mental condition and a disease, because no one desires to become addicted. Why would anyone want to get addicted and commit crimes? That’s just crazy talk. If they wanted to commit crimes they could just commit them. Why do drugs too? But that’s why we need drug laws, because in the absence of drug laws, intoxicated behavior and the neglect of personal responsibilities (e.g. parenthood) by some drug users would constitute a social problem. Does a child deserve to be neglected due to a parent’s drug use? Carl Hart debunked the myth of drugs causing widespread child neglect and other social ills, and actually showed that drug laws create more problems than they solve. But we can safely dismiss such ‘ivory tower’ thinkers who know nothing of the reality on the street.
Addiction is not a lie
Now some people might say that addiction is a lie and that addicts are simply liars who commit crimes under cover of ‘addiction’. However, George Vaillant, Harvard psychiatrist, 12 Step proponent, and the ‘father of modern alcoholism science’ proved in the 1940’s that personality traits such as sociopathy and lying develop after addictions, not before them. And this research was so persuasive that no one has ever tried to replicate it since, even though most addicts are self-admitted liars and ‘master manipulators’, and even though addicts lie freely about how much drugs they take (in both directions) to manipulate the criminal justice system, as I’ve shown. Also, people who fall into substance abuse disorders frequently delude themselves about the effects drugs have on them, so we can safely rely on their self-reported experience of addiction, such as when they say, “The drugs made me do it,” as long as they admitted to a history of dishonesty and denial regarding the effects of their drug use, which is the only logical explanation of why they did it without any apparent attempt to stop. Also remember that the nondrinker will be uncomfortable and unwelcome among drinkers and drug users, so is not in a position to observe and judge them fairly. We must rely on their own reports such as may be heard at a 12 Step meeting, or by the experts who treat them, and know them best because they were once addicts themselves.
Policy recommendation: better treatment for the disease
For our policy recommendations, we would point out that some treatment providers are proven significantly better than others. So we would like to see a push to use the evidence base, and we think these should be supported. However, bear in mind that when it comes to the evidence base, most treatments are analyzed and reviewed by the people who developed them, so the conclusions are unreliable. Furthermore, we cannot rely on science, because science has its own goals and purposes, and its participants have their own career strategies, which may be at odds with the needs of policymaking. There is a conflict between good science and policymaking. The reason is that no scientist will win the Nobel Prize for reducing the violence caused by drug addiction, and scientists are typically liberal and their values often differ from the average person. Not to mention, research on drug abuse can create powerful enemies. Just ask the scientists who demonstrated that DARE is ineffective (assuming they are still alive lol). So they then create bad research, which then influences policy. So while we think everyone should get serious about gathering real evidence, we don’t actually recommend it officially. It’s just not possible.
There is simply a dearth of research on whether Treatment Communities (12 Step based treatment) work, or that treatment doesn’t actually create addiction, but we don’t recommend more research due to the fundamental problems with it mentioned above. To paraphrase Mark Twain, there are 3 types of lies: lies, damned lies, and drug statistics. Nevertheless, we have some evidence that treatment is actually harmful. In CA drug diversion treatment (prop 36), we found that those who failed to show up for rehab were less likely to be rearrested than those who went to some treatment but dropped out: 55% compared with 60%. Nevertheless, we can say confidently that the 12 step approach is well suited for some. At least, they insist that it works and it’s the only thing that ever worked, so there is no harm in trying it. Also, these programs are free, and in cash strapped jurisdictions, the value of free treatment for such a destructive disease cannot be dismissed. Parents of teens who are recently released from inpatient treatment programs may scramble to find an aftercare program, so this may be the only option. Even though it’s been shown to be more dangerous than no treatment at all.
Treating addiction as a disease is mostly ineffective, and programs like DARE are ineffective, as are public service campaigns against drugs. The serviceability of the media in the drug-prevention field is used as a bogeymen with which to frighten children (and their parents), also to no effect. Much to our surprise, however, we discovered that encouraging good behavior, such as with the Good Behavior Game (GBG), and swift and certain consequences for bad behavior actually creates a long term improvement in behavior and decreases drug use. Even in the absence of treatment for drug use or addiction. This is surprising because addiction is a disease, and yet can be treated as if you were training a puppy. This may be the most amazing scientific mystery of all.
We are now seeking funds to show whether brief jail terms can be used to fight cancer relapses and AIDS.