The War on Drugs : The Frontal Cortex

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Jonah Lehrer is a contributing editor at Wired. He's also written for The New Yorker, Seed, Nature, the Boston Globe and is a contributor to Radio Lab. He's the author of Proust Was A Neuroscientist. His new book is How We Decide.

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The War on Drugs

Posted on: December 19, 2007 9:55 AM, by Jonah Lehrer

Ben Wallace-Wells, in Rolling Stone, recently wrote a fantastic and tragic article on America's War on Drugs:

All told, the United States has spent an estimated $500 billion to fight drugs - with very little to show for it. Cocaine is now as cheap as it was when Escobar died and more heavily used. Methamphetamine, barely a presence in 1993, is now used by 1.5 million Americans and may be more addictive than crack. We have nearly 500,000 people behind bars for drug crimes - a twelvefold increase since 1980 - with no discernible effect on the drug traffic. Virtually the only success the government can claim is the decline in the number of Americans who smoke marijuana - and even on that count, it is not clear that federal prevention programs are responsible. In the course of fighting this war, we have allowed our military to become pawns in a civil war in Colombia and our drug agents to be used by the cartels for their own ends. Those we are paying to wage the drug war have been accused of human-rights abuses in Peru, Bolivia and Colombia. In Mexico, we are now repeating many of the same mistakes we have made in the Andes.

I think it's pretty clear that, as Wallace-Wells puts it, the War on Drugs "is one of the most sustained and costly defeats the United States has ever suffered."

What does this have to do with neuroscience? I think neuroscience is our last, best, and only hope of actually dealing with the drug problem. While addiction is an extremely complicated phenomenon, we now know that the brain utilizes a single chemical mechanism - the dopamine reward pathway - for everything from heroin to gambling to cigarettes. Of course, the molecular details differ in each context, but the general principle is the same. If science can find a way to selectively block the addictive properties of dopamine - without inducing a terrible range of side-effects - the societal payoff would be immense. Of course, nobody is sure that such a pharmaceutical is even possible, but even if scientists can engineer a mildly effective treatment that only works for specific substances, I think it would dramatically change the way we approach the War on Drugs. Addicts don't want to be addicted. For the most part, they want help. We just don't know how to help them.

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Comments (17)

If science can find a way to selectively block the addictive properties of dopamine - without inducing a terrible range of side-effects - the societal payoff would be immense.

And how about a perpetual motion machine to go with that order?

Posted by: daksya | December 19, 2007 10:51 AM

Chantix does something similar and it seems to work well. Though it blocks the nicotine receptors prior to the production of dopamine.

http://www.chantex.info/chentix_works.htm

Posted by: Eric Juve | December 19, 2007 11:03 AM

I work on dopamine, although not in terms of addiction (more computational stuff). Contrary to what daksya said, creating an anti-addiction pill is not equivalent to a perpetual motion machine. for one thing, the laws of physics dont stand in our way. but we also know a lot about dopamine and how it works. the problem, as jonah pointed out, is largely a question of side-effects. you knock out dopamine and you induce parkinsons. but lots of people really are optimistic that, if you can find a way to target specific dopamine receptor subtypes and in specific brain areas (insula?) you'll get something effective.

Posted by: margaret | December 19, 2007 11:20 AM

An article entitled Bodies in Motion, Clean and Sober that appeared in the NY Times on October 12, 2006 claims that replacing bad addictions (to drugs, alocohol, etc.)with healthy addictions (to intensive physical training such as marathon running, Ironman competitions, etc.) works for some addicts. Is the dopamine reward pathway involved in some sports?

Posted by: peggy | December 19, 2007 11:27 AM

margaret, the analogy was meant in terms of plausibility, not underlying barriers*.

the problem, as jonah pointed out, is largely a question of side-effects

Isn't that an understatement? Dopamine is an integral requirement for human biological function. Blocking the 'addictive properties' of dopamine may very well seriously hamper overall health of the body and the psyche. Drugs aren't biologically special, unlike their legal status. You can stop cocaine by gobbling most of it up in the bloodstream before it enters the brain (similar to the nicotine vaccine cited above) but the interaction between cocaine and its receptor targets will have to target cocaine rather than the receptors. Doing the latter is likely to have unpredictable effects, even assuming it doesn't hinder essential biological cycles. And if you decide to target cocaine, well, then there's other drugs out there. This applies even if you decide to go inhibit specific Dx complexes.

The hope that Jonah puts forward is reminiscient of the ideas by the folks behind HedWeb.

*many contemporary philosophers of science treat the "laws of physics" as descriptive generalizations rather than prescriptive iron-clad barriers, so a perpetual motion machine may be extremely unlikely but the "laws of physics" aren't in our way, they just define the implausibility.

Posted by: daksya | December 19, 2007 11:56 AM

"Addicts don't want to be addicted."

The way to stop addiction is to stop using. It isn't as complicated as we in the past many years have made it out to be. Addiction has now attained the status of a disease over which the person has no control. Enter the entire industry (read big bucks $$$) dedicated to "helping" addicted people stop whatever it is they are addicted to... replete with sponsers and higher powers and still the addictions go on.

Addicts don't want to be addicted...., nor do they want to stop using forever and that's precisely why they don't.

For the most part, they want help. We just don't know how to help them.

Posted by: alice | December 19, 2007 3:26 PM

"For the most part, they want help. We just don't know how to help them."

That was not supposed to be the last sentence in my prior post.

That being said, I will say that the way to help an addict would be to let that person know that the decision to use or not to use is entirely up to them and entirely within their power.

Posted by: alice | December 19, 2007 3:31 PM

When our government spends half a trillion dollars fumigating farmers' land in foreign countries and building jails and jailing the poor at home, while not achieving its stated purpose but becoming more vigilant in pursuing those policies that have consistently "failed", it's time to question that stated purpose.

So perhaps the "War on Drugs" is not "one of the most sustained and costly defeats the United States has ever suffered", but something else entirely.

And "Those we are paying to wage the drug war have been accused of human-rights abuses"--"human-rights abuses" being a euphemism for torture and mutilation--are usually trained by us to commit human-rights abuses. So here we have another assumption to question--long, long before we approach the neuroscience of dopamine, if we're to approach the drug problem seriously.

Posted by: khalid | December 19, 2007 3:49 PM

Aren't we implicitly buying into the martial metaphor, "War on ..." by allowing social policy debate to be framed in those terms? Does that framing in itself hamper our mental machinery in coming to grips (more metaphors) with social and individual problems and their possible solutions? Just a thought.

Posted by: Alan | December 19, 2007 5:02 PM

daksya wrote:

"*many contemporary philosophers of science treat the "laws of physics" as descriptive generalizations rather than prescriptive iron-clad barriers, so a perpetual motion machine may be extremely unlikely but the "laws of physics" aren't in our way, they just define the implausibility."

But it is funny how that pesky Second Law of Thermodynamics keeps getting in the way...

The problem is basically one of economics; we have too many people on the payroll who have to be fighting 'the war' on something to stop it. Prohibition may have been repealed, but very few 'revenuers' got laid off. They just found something new to be paid to prohibit.

So it goes...

Posted by: Vnend | December 19, 2007 9:55 PM

OT: How come trackbacks don't work on any of the scienceblogs?

Posted by: Steve | December 19, 2007 10:45 PM

Maybe you should look for a way to control the neurology of wanting to look through your neighbors stuff and inspect their urine to make sure they aren't having more fun then you. That would be a better solution.

Much of history can be read as a series of conflicts between different methods of altering consciousness with drugs. From this we learn that the urge to alter consciousness with drugs is one of the oldest, most universal human traits.

Trying to eliminate the negative effects of drug addiction by altering peoples ability to react to drugs is exactly like trying to prevent teen pregnancies or sex addiction by stopping people from having orgasms, or fighting obesity by cutting out the taste and smell receptors in the tongue.

Neurology could interact with drugs in many more interesting ways. For example, we could figure out how to lessen the negative effects of drugs and stop them from harming people, while still letting them get the high they have evolved to seek. Or we could use psychedelics to study consciousness and religion and creativity. Or why one dose of ketamine can knock out depression for months.

Also, unrelated to neuroscience, but for many addicts changes in socioeconomic areas could do more to help addicts than neurology, because the addict is making a rational choice in response to mental illness (which they cant get treatment for) or abject poverty. Addicts don't care about being addicted. They care about not being in pain for a while because they are that desperate.

Also, addict is a term that dehumanizes people and makes their drug use seem like the center of their being, in the same way that racial slurs make a persons ethnicity the center of their being. Their is even some evidence that the way the word sounds is part of a pattern of cutting people off from their humanity, (compare "Kike", "Towelhead", "nigger", or modern rhetoric about mexican immigrants and people of arab descent.) so that a ruling elite can consolidate power for their own benefit by uniting people against the marginalized group. Should sound familiar to anyone who follows politics.

Permanently changing peoples neurochemistry to fight the War on Drugs seems like a horribly bad idea. We KNOW that this would be used on people without consent, or on children, if it is developed. We know that it would be used by oppressive regimes (like our own) as a political weapon. Bad mojo. You want to end the war on drugs. Stop acting like it's a war, give people hope and economic security, stop defining them by their drug use, stop letting the black market generate wealth for criminals by supplying people with potentially tainted drugs, stop fighting peoples natural healthy desire to use drugs to alter consciousness, and stop worrying about if your neighbor is having more fun then you.

I guess this is to say that addiction has very little to do with the war on drugs.

Posted by: TomK | December 20, 2007 3:56 PM

Addiction has now attained the status of a disease over which the person has no control. Enter the entire industry (read big bucks $$$) dedicated to "helping" addicted people stop whatever it is they are addicted to... replete with sponsers and higher powers and still the addictions go on.

Posted by: kozmetik | December 23, 2007 4:04 PM

Um... addiction is a disease. As far as I can tell, your brain is what tells you "Do this" or "Don't do this". If a drug hijacks your wiring, and forces you to "Do this" even if you consciously desire not to, that's a disease. A person can actually die from seizures related to drug or even alcohol withdrawal.

Not saying that all people who want to help ("cure") addicts are bright and shiny and have perfectly angelic intentions, but it is a mental health problem that does need to be addressed, and those who suffer from addictions may legitimately need help quitting.

Posted by: Muse142 | April 23, 2008 5:57 PM

While addiction is an extremely complicated phenomenon, we now know that the brain utilizes a single chemical mechanism - the dopamine reward pathway - for everything from heroin to gambling to cigarettes. Of course, the molecular details differ in each context, but the general principle is the same. If science can find a way to selectively block the addictive properties of dopamine - without inducing a terrible range of side-effects - the societal payoff would be immense.

Dopamine has little to do with addiction in a direct way. The acute dopaminergic responses to various stimuli are consistent with a role in "reward" so to speak. Consistent with the euphoria of acute drug taking, sure. But tons of people get these effects and are not drug addicts. The idea that they somehow get "higher" for a given acute drug experience is, I suppose the rationale but there is not a lot of good evidence for this in terms of functional neurochemical differences.

Current research is delving into alternate neurochemical systems and, indeed, is getting away from this outdated notion that dopamine and/or the acute reinforcing properties of drugs are getting us to the answer.

That being said, I will say that the way to help an addict would be to let that person know that the decision to use or not to use is entirely up to them and entirely within their power.

right. because that strategy of "hey, just QUIT already, would'ya" has been so fantastically helpful.

all the industry and big $$$ devoted to cancer which has now attained the status of a "disease" instead of "gee, time to die dude". and still the cancers go on....

All snark aside, really you people. Where do you come to "understand" addiction so well? On what basis do you base your pronouncements? Do you think that people should just "decide not to have" Parkinson's and Alzheimer's too? Cardiovascular disease is some invention of BigPharma?

Posted by: DrugMonkey | April 23, 2008 6:01 PM

There are no mental illnesses, just personalities. When are people going to learn what motivates one to be obsessed with drugs motivates another to be obsessed with physics or sports. You can't just 'block' a drug in the brain without affected other ambitions. Who is to say what the perfect personality should be anyways?

Posted by: Andy | April 23, 2008 6:27 PM

Alice: "The way to stop addiction is to stop using. It isn't as complicated as we in the past many years have made it out to be."...."That being said, I will say that the way to help an addict would be to let that person know that the decision to use or not to use is entirely up to them and entirely within their power."

Alice in Wonderland I suspect?

Schizophrenics behaviour in relation to cannabis (and tobacco) is perhaps a blunt attempt to self medicate and has led to some interesting lines of research including claims that cannabidiol is comparable in effectiveness as atypical antipsychotics. I suppose patients could be told to "just say no" to their voices? (as if they haven't tried).

I suppose attempts at symptom reduction of pain using opioids is really covert drug seeking behaviour and not symptom relief? "Just say no" to pain - if pain persists it's because you are weak willed and not trying hard enough!

A persons motivation in tackling many medical or psychological mediated interventions is important but to state to an addict that their addiction is _entirely_ up to them is cruel simplistic individualism. Free will is ultimately biochemically based.

Andy: "There are no mental illnesses, just personalities" - another cruel and vexatious post.

After finding out that an extremely bright, functional, productive and intelligent colleague has been a frequent heroin user for the past 20 years, I'd suggest that one aspect of dealing with addiction is a plentiful quality supply. Another aspect are drugs which are well targeted - where the underlying process is (and of course this is an oversimplification) relatively 'simple'.

I've often wondered how 'problem' gamblers would fare if given an infinite supply of real cash (perhaps metered or doled out by another person according to rule based criteria) that is not accessible for any other use other than meeting their gambling needs? Would this, for example, remove the element of risk of loss (financial hardship, negative interpersonal social consequences) and lessen the 'dynamic response' of the underlying reinforcing biological processes?

In relation to Chantix, while I see the value of _helping_ to break the withdrawal-reward cycle of smoking (and associated behaviours) through partial agonist and antagonist mechanism, if the agonist is potent enough removal of it would result in withdrawal symptoms - i.e., one could become hooked on Chantix. My experience with Zyban is that it is an effective antagonist (one doesn't get the hit from a cigarette yet the cravings are still there) but is more effective if used with patches or gum. A difficulty I've observed is the pharmacokinetics of nicotine use vis-a-vis the rapid 'hit' via a cigarette vs the slow response of gum and patches.

What we need to face up to is that drugs with addiction potential meet a need - that is for the most part they work. Alcohol is an effective 'social lubricant'. In the case of drugs that have impure and harmful means of delivery e.g., nicotine via smoking I think alternative rapid and safe means of delivery (nasal spray, vaporiser) work just as well without the terrible harmful effects. Alcohol substitution is also possible with drugs that have less damaging effects.

The real 'war on drugs' should be waged against Governments who perpetuate dirty supply, who are hooked on tax revenues (but even this could be maintained via taxing substitutes) and maintain high prices as well as drug companies (including tobacco) who have failed to innovate. The bulk of the two most damaging drugs in common use could be substituted.

However, methamphetamine and crack cocaine are much more difficult to substitute given the rapid and intense rewards they produce. I struggle to imagine (apart from taking away the illicit economy via regulated supply) what a harm minimisation scheme for ice would look like nor do I know of any substitutes (a readily available fast antidote would be most welcome).

Peggy, re: Bodies in Motion might be part of the answer when it comes to stimulants with euphoric effects. Perhaps if our children from a young age and into adolescence were given better access to more extreme exhilarating natural joyful experiences (skydiving?) more often the effect of crack and ice might not be seen as effective - but I think this could be wishful thinking.

Clearly, the 'war on drugs' is on the whole ineffective, misguided and wrong - the two most damaging drugs are widely available and regulated.

Posted by: Deus_Abscondis | May 8, 2008 6:20 PM