Adventures in Ethics and Science

At Bioephemera, Jessica Palmer notes a disturbing double standard:

[T]here’s a huge double standard in the media, and in society in general, when it comes to drug abuse treatment. I spent two years as a AAAS Fellow at the National Institute on Drug Abuse, and it was both depressing and inspiring: I was deeply impressed with the dedication of the staff, and horrified by the immensity of the problem of addiction in this country. That’s why it upsets me that while research to help smokers quit is generally portrayed as necessary and important, increasingly, I’m seeing politicians complain that research to help other drug addicts quit is a waste of money.

Maybe it’s because these other addicts are meth addicts, or potheads, or heroin addicts – probably not people you relate to or approve of. That makes it pretty easy for the media to take cheap shots at crack, etc. addicts, and question whether we should waste money trying to help them. But we should get angry about these cheap shots. A crack addict will die faster than a smoker. A crack addict can rarely hold down a job or be a parent. His/her illegal addiction poses a bigger danger to society than a smoker’s does. Most importantly, a crack addict, like a smoker, can quit. Tobacco is still a significant public health problem, and I want to do all we can to help smokers (like my mom) quit, but crack, meth, etc. utterly destroys families and communities. We should be leveraging scientific research every way we can to help these people – not throwing them away or taking shots at them because they’re “bad,” or because we can’t relate to them. They’re real people. They have families.

You should, as they say, read the whole thing.

Here, I want to pick up on the question of what kind of research the public (or the pundits trying to prod the public one direction or another) have a hard time getting behind. We’ve discussed the general issue before, and even spent a little time talking about the specific issue of research with addict populations. But we haven’t dealt head-on with the kind of objection that a segment of the American public may have, specifically, with putting up public funding to support research on the effects of drugs on people’s bodies, brains, behaviors; on effective ways to treat or manage dependence or addition; on genetic or environmental factors that might make some people more susceptible to dependence or harm.

That objection is described fairly succinctly in one of the comments on BioE’s post:

A very large and vocal swath of America views illegal drug use as a moral failing. These same people nearly always believe that those with moral failings deserve to suffer. In their eyes, anything that reduces the suffering of those with moral failings is evil. …

The problems you have described are a direct result of our culture’s long standing tradition of framing undesirable behaviors as moral failings.

Let’s consider the proposal that resistance to funding scientific research on drugs of abuse or on treatment is, at bottom, motivated by the view that taking drugs is a moral failing.


(I’m curious to know how many people holding this view include alcohol and tobacco as drugs. Or caffeine. Or psychiatric drugs. Or drugs to reduce cholesterol, or acid reflux, or wrinkles. Or drugs to address erectile dysfunction, or diabetes. Where on the “drug facts” label is the language that will identify which of the many substances that interact with our bodies and brains are moral and which are immoral? Is legality the relevant line here, as the commenter I’m quoting suggests, or something else? If the “legalize it” crowd were to succeed in the push to get marijuana decriminalized, would its use move to the morally acceptable column?)

The implication of the view that taking drugs is a moral failing is that if you make this wrong choice, you fully deserve everything that follows from this choice — and you ought not receive any assistance in undoing the mess that your wrong choice got you into.

(Drug use is a moral failing but investment in mortgage-backed securities is not, apparently.)

Science can ask all the questions it wants about drugs, then, but not on our dime. We already know everything we need to know about drugs. Using them is bad … which must mean only bad people use them. Bad people deserve punishment, so the nasty effects of drug use are entirely appropriate.

Of course, even if we were ready to stipulate that the people who take drugs are all bad, they are not the only people who get to deal with the nasty effects.

These effects may impinge on their ability to do their job, which can impact their employers, their co-workers, the people who depend on the goods or services their workplace produces, not to mention, further out, impacts on things like tax revenues and GDP.

There are also people too young to be holding jobs to consider here. The kids who are taking drugs may be impacting their ability to grow into responsible adults, who can hold jobs and otherwise contribute to their communities. They may be making things even harder for the teachers trying to teach them in school, or for the kids sharing the classroom with them to learn. Even if you’re prepared to let a child suffer lifelong consequences for a choice you see as morally wrong, it’s not clear that they won’t be causing significant harm to others on the way — including their families, their friends, their neighborhoods.

(Having kids of my own, this is not an abstract question for me. I know my kids are likely, in the process of growing to adulthood, to make some choices I’d rather they didn’t. My hope is that this happens in a way that avoids permanent damage all the way around.)

If the nasty effects of their bad choice are such that folks taking drugs can’t get or keep jobs (or otherwise take care of their families), there may be impacts on social service programs (whether governmental or private) that they rely on for help getting food and housing, or that might be called in to intervene if the safety of their kids or partners or elders were in question. There may be impacts on hospitals, where the folks taking drugs may end up relying on the emergency room for medical care (since if you can’t keep a job, chances are good you don’t have the health insurance that would cover regular non-emergency medical visits). These costs will get shared with the rest of the public — even the people who have avoided the moral failing of taking drugs.

As will the costs of law enforcement, if the people taking drugs resort to crime to support their drug habits. As will the costs of incarceration, if the people taking drugs are taken off the streets to protect the rest of us from that crime. We get to foot the bill for the effects of other people’s “moral failings” here as it is. Why, then, should it be so objectionable to consider spending some public money to figure out how to help people stop? Is it so important that people be punished for their moral failings that we’re willing to sustain large-scale societal collateral damage just to enact that punishment?

Because honestly, I’m not sure that this kind of vengeance is terribly moral. Even if it were fair to the person making the choice you view as morally wrong, it seems pretty unfair to all the other people who will also be hurt.

Why can’t we, as a society, turn to scientists to get reliable information on how drugs impact human bodies, brains, and behaviors? Why can’t we fund scientific research to develop effective ways to treat drug dependence — to help people who want to stop doing this thing so many people view as morally wrong? Why can’t we get behind research efforts to determine what kinds of genetic and environmental factors make people — including kids — more vulnerable to dependency, or to the harms that may impact a much larger circle of people?

Couldn’t better knowledge help people make better choices?

Couldn’t better knowledge help society minimize some of the collateral damage from the bad choices that have already been made?

And really, seriously, are we committed to a one-strike policy with bad choices, with no room for compassion or fresh starts? Is that really who we want to be as a society?

It’s not who I want us to be. I’m not ready to take a stand that amounts to throwing away a family member, a friend, a coworker or student, a neighbor, even a stranger, for one bad choice — especially if they are looking for help to change. I’d rather we be a society that stands ready to help people change — and to help get them the best information we can that will support the change they’re trying to make. It’s not just in their interest, but in ours, too.

Comments

  1. #1 Dr. Kate
    November 4, 2009

    Hear, hear.

    And I think a lot of this could apply equally well to research on other behaviors considered to be “moral” issues–such as STD transmission among sex workers (which, from what I understand, is equally difficult to get funding for) or even societal/health/emotional effects of adultery. Or, heck, solid data on the effects of various factors on teenage sexual activity.

    We as a society need to stop avoiding research topics because they make us uncomfortable. Especially when those topics have such a clear and obvious effect on society.

  2. #2 becca
    November 4, 2009

    Well of course taking drugs is a moral failure… but only for Rush Limbaugh.
    And tobacco smokers. Tobacco pisses me off.

    Although I can see the argument for ‘drugs as a moral failure’ when it comes to drugs for eyelashes or wrinkles. Vanity isn’t just a moral failure, it’s a deadly sin. And drugs for type II diabetes? gluttony and sloth. ED? lust.

    Anyway, I think some people need to view drug use as a moral failure because of the negative effects on other people. Hence, why tobacco pisses me off.

  3. #3 RM
    November 4, 2009

    I don’t think it’s a moral-failing issue, I think it’s an illegality issue. Illegal drugs are illegal, and therefore doing them makes you a criminal, and the prevalent US belief is that criminals are not worth anything as human beings. Prisons are there to serve as dumpsters for human garbage.

    e.g. see the recent tussle over H1N1 vaccinizations in prisons. Spending *any* money on criminals (for their benefit) is done begrudgingly, if at all. If media is a window into culture, just look at the attitudes toward the accused shown in prime-time cop dramas – any sort of action is okay if it causes the “dirt-bag scum” to get locked up.

    There may perhaps be some moral failing thrown in there too – people probably won’t want to spend public money on depression treatments or weight-loss treatments, even for non-criminals, but I doubt with the same outrage and vehemence. I think most of the objection is due to regarding prisoners as trash, and you don’t spend any money on trash, except for paying to have it hauled away.

  4. #4 llewelly
    November 4, 2009

    Thank you for highlighting my comment.

  5. #5 Dario Ringach
    November 4, 2009

    Those that view addiction as a moral failure must be the same group that considers addiction to be a personal choice, not a disease.

  6. #6 Mike Olson
    November 4, 2009

    Aside from labling it a disease, how is it a disease? It is obviously not viral. It is not bacterial. An addict doesn’t have different bio-chemistry that creates a need to use. Although there are genetic factors that can contribute, in many situations it could be that a person learned the behavior from a parent. I agree that more research is needed on addiction. I also think that having a whole problem defined by one group that responds to that problem is ridiculous. AA is a religious group plain and simple. They are the group responsible for defining the issue as being either a) a moral failing or b) a disease. Why can’t it be something else entirely? Namely a behavior. A self-destructive behavior. I agree addiction should be something we treat and deal with. But, suggesting that every behavior is either a moral failing or a disease begs trouble. Especially, when AA’s treatment involves a fourth step that is about taking a moral inventory, after coming to believe that God(or a higher power) will cure your disease.

  7. #7 fsdsafsd
    November 4, 2009

    AA are a bunch of crooks preying on people’s addictions as a means to indoctrinate more people into their cult unfortunately. It’s a shame their group hasn’t been more readily criticized.

  8. #8 Dario Ringach
    November 4, 2009

    I only said that those that view addiction as immoral must be the same they view it as choice. I did not say that my position was one that addiction is a disease. I personally think that, as always, the truth is more a bit more complex. Read Alan Leshner on the topic here – http://tinyurl.com/ye439ky

  9. #9 llewelly
    November 4, 2009

    Mike Olson | November 4, 2009 8:52 PM:

    An addict doesn’t have different bio-chemistry that creates a need to use.

    In several important cases this known to be untrue. For example, schizophrenics and nicotine.

  10. #10 Mike Olson
    November 4, 2009

    I’d have to say that those were two of the more informative links I’ve read in a long time. Thank you for providing the information. I’d have to say the first link strengthens my belief and gives me greater insight to suspicions I already had and the second demonstrates that “addiction” is less a disease in and of itself(in that particular instance), so much as an attempt to self-medicate in the presence of a disease to create a sense of normalcy. I whole heartedly agree the issue is complex and multi-faceted. Thanks again for your feedback!

  11. #11 G.D.
    November 5, 2009

    Not a very surprising sentiment. After all, a lot of Americans are committed to thinking that a single wrong guess with respect to what the correct metaphysics of the universe is can justify you being tortured in hell for all eternity. In comparison, thinking that drug addicts deserve all the suffering that follows from a couple of instances of poor judgment sounds almost reasonable.

    (for the records, I take the absurdity of the second claim to be a reductio of the first, if any were really needed).

  12. #12 Paul
    November 5, 2009

    One of my main concerns about the trend to defund research into areas such as drug and alcohol research is that it will force more scientists to rely on funding from the tobacco and alcohol industries. Of course such industries have their own agenda’s (primarily PR) which are quite unlikely to coincide with that of the scientists, and of course if the research requires the use of animals scientists accepting industry funding the scientists are making themselves easy targets for animal rights extremists. People are less likely to rally in support of a scientist who appears to be receiving funding from ethically dubious sources.

    You wrote a good post on this topic last year http://scienceblogs.com/ethicsandscience/2008/02/a_tangle_of_controversy_and_a.php

    So unless more charity funding becomes available the reality is that the amount of research in this important area will fall, since many scientists will not want to depend on tobacco and alcohol industry funding and will switch their research to less controversial fields rather than compromise themselves.

  13. #13 Mike Olson
    November 5, 2009

    Perhaps this is a PR issue as well. I’m all for funding, particularly because addictive issues are in fact public health issues as well as economic issues. Not in the sense provide by the link at #8. The link provided indicates that addicts are hosts and goes on to describe variety of ways that would continue to frame addicts as suffering from a disease. My point is this: How is it better to tell someone they are mentally ill(have a disease) than to tell them they are morally reprehensible? Generally, most of us don’t do certain drugs because we are afraid. What are we afraid of? That we will get hooked! It will feel so good we can’t stop! This will lead to a life, in which we engage in ourselves in a declining ability to function. I don’t think that wanting to feel good is a mental illness. Nor do I believe that a failure to delay gratification is an illness. The thing is different people react to different drugs in different ways and the level of dysfunction, as well as the actual threat to health or society differs depending on the individual, the drug, their reaction to it and the conditions in which the drug is used. Tobacco has had a huge, negative impact on our society and cost a great deal of money. But, on a daily basis smokers aren’t really hurting themselves or others…it it the long term effects. I’d also point out that smokers generally aren’t told they have a mental illness(disease) which requires life long treatment. On the otherhand crack, meth and heroin have such ill effect so quickly that the detriment to self and society is quickly, readily apparent and without experiencing the drug it is easier to label those folks morally bankrupt or mentally ill(diseased) to continue their actions. I believe we need to have a new paradigm through which to view this problem which is more intellectual, scientifically and behaviorally honest than simply labling it under a blanket term such as a disease(with no particular etiology).

  14. #14 becca
    November 5, 2009

    “But, on a daily basis smokers aren’t really hurting themselves or others”
    As a child of heavy smokers, poppycock!

  15. #15 Mike Olson
    November 5, 2009

    Comparatively speaking. I should have been more clear. My intention was not to downplay the long term effects of second hand smoke. Nor is it to imply that I don’t think there are toxic effects involved in smoke inhalation. But, if your parents had been using mushrooms and actively halucinating as they raised you…the detrimental effects would have been more pronounced on both you and your parents…and no, I’m not looking for a discussion of AmerIndian religious rites and how they are not drug abuse…although I’ve left myself open to that, since I’ve not specifically addressed it!

  16. #16 becca
    November 6, 2009

    Actually, now that you mention it, I’m not sure my parents weren’t actively halucinating as they raised me (LSD flashbacks from the 60s?)… it would explain a lot.
    Honestly? My parents tobacco smoking made my life much more difficult than that of friends whose parents smoked pot (discretely).
    I hated smelling like cigarettes all the time, hating being around the smoke, and I got major sinusitis that affecting my swimming which I’ve always thought was intensified by the smoke exposure. Not to mention the time the house burned down…

    The quibbling aside, I do think that the way we view drug use and addiction (including terming addiction a disease) is not particularly useful.

  17. #17 Jennifer B.
    November 6, 2009

    Mike Olson, what about alcohol? Alcohol causes psychological changes that are just as (if not more) severe than, say, psilocybin-containing mushrooms. And yet, not only is alcohol consumption societally-accepted, in many situations it’s encouraged.

    Also, I think your definition of a ‘disease’ as something caused by a virus or a bacteria is severely limited. Schizoprenia, as an example is a disease, despite its lack of an external cause. For that matter, you’re excluding diseases that have a genetic basis, such as cystic fibrosis. And autoimmune diseases such as Crohn’s and MS. And any disease that is currently considered idiopathic.

    Now, I’m not saying that anyone who might have a brain chemistry that is susceptible to addiction (to any substance, legal or illegal) suffers from a disease, any more than someone with a susceptibility to high blood pressure has a disease. But when an individual develops an addiction, I believe that we as a society have an ethical responsibility to treat that addiction as a disease, in the same way that we treat high blood pressure as a disease.

  18. #18 Mike Olson
    November 6, 2009

    First of all, in regards to alcohol I indicate it doesn’t have a specific genetic cause. I went on to state that an alcoholic or addict doesn’t have a specific bio-chemical event that leads them to use. My intention was not to indicate that there are no genetic diseases or auto-immune diseases. I simply asked how addiction was a disease. Drunkness is a condition. Drinking is an action. Alcoholism is a series of actions. Many currently do the same thing with over eating. Obesity is a condition, not a disease. Eating is an action. Gluttony is a series of actions. I honestly appreciate the discussion as it is of major concern to me. I’ve read, BTW, that some of the “pre-curosors” to addiction in mechanism to those found in schizophrenia. Thus far, there has not been found a specific schizophrenic gene. Differences have been found on three different genes, but not in all patients. Also, there is some indication that the mother being ill in, I believe, the first tri-mester, may influence later development of schizophrenia. In the case of addiction, there are genes that can lead to depression, impulsiveness and generalized feelings of anxiety, or a lesser ability to deal with anxiety. However, these don’t determine that a person is an alcoholic, not all alcoholics have these issues, and there is a question as to parenting and learning. I don’t mean to be leave questions, I’ve read widely in popular literature on genetics so I can’t cite sources. In regards to addiction, as I’ve said, my intention is most definitely not to yank chains and it is personal to me. I simply seek information and honest opinion. I’m unhappy with, “the recovery movement” and find much of their definitions to be short cited, poorly informed with a lot of misinformation. In regards to their, “treatment,” I personally am a believer. But, I have a real problem with someone describing something as a disease, not a moral issue, than telling people they have to find God and take a moral inventory they are then expected to share with a crowd. To make matters worse, I don’t feel that a person is “born again” upon finding AA. Drinking is a bad habit and those who indulge have good and bad qualities while drinking and after going to recovery. As I said, I’m simply looking for genuinely non-partisan information and opinion.

  19. #19 costanza
    November 8, 2009

    Just as there is a totem pole as to what addictions are popularly considered “worse” than others (ie caffeine is better than tobacco, which is better than alcohol….) this totem pole exists in the “community” of addicts. My father is a recovering alcoholic, and I asked him once if a heroin addict would be welcome in one of their mtgs. “Certainly not!”, he replied. We entered into a rather heated discussion as to what I thought was a callous and snobbish attitude. I ended the discussion when I pointed out that the only real difference between an alcoholic and a heroin addict was that alcohol is legal. A reflection perhaps, of this attitude of addictions as moral failings.

  20. #20 Mike Olson
    November 9, 2009

    If you’re dysfunctional due to an addiction, there is no difference. You engaged in something til you couldn’t live life. On the other hand, there aren’t a lot of folks whom you could call “weekend heroin addicts.” Sorry, but I see reality for what it is. There is a big difference between someone who has a pot of coffee everyday, someone who has a six pack everyday, or someone who has a shot of heroin everday, as well as a difference in someone who has a six pack on Friday and/or Saturday. All things being weighted on working a normal five day day shift job. Again, if you’re using it to the point you can’t function…it doesn’t matter what it is. But, it seems to me that any more it is a sort of politically correct sort of egalitarianism that lumps all addictions regardless of level together, as well as labling a variety of behaviors a disease. This all goes back to the Christian basis of the recovery movement which argues that all of us are equally sinful and equally in need of grace. BTW, I’ve heard that story about alkies refusing various addicts entry, but in seven years of attending meetings, most meetings…AA meetings were populated by coke, meth and crack addicts. To find someone who just drank beer would be a huge stretch. No one whose been attending meetings in the last fifteen years feels there is any difference. Look, there is a whole vocab around this movement: sober isn’t sober…sober is attending meetings etc, etc and working the program. Sober without meetings is a dry drunk. Look, this is why I get crazy over word usage and meaning. This movement changes the meanings of words to pull people in, and fails to acknowledge any sort of difference between behaviors…In other words a guy who used heroin and lived on the street for five years and dropped out of high school is free to lecture the Phd who maintained function but drank too much on weekend nights…never doing anything wrong…simply over indulging. The whole hierarchy is based on “time in sobriety,” and dedication to the attendance of meetings. Not understanding of the book, the concepts, a willingness to help others or even faith in God. It is AA first, and the only path to success is to conform to every belief they have. Which includes the belief that alcoholism is a disease, whose only treatment is faith that a Higher Power, will keep you sober, as long as you take a complete moral inventory. A “disease” that is not a moral failing that requires faith, a moral inventory and an admission of guilt…in order for the treatment to work. This is all based on Bill W’s spiritual awakening after becoming involved in an evangelical Christian group. Again, I don’t believe that drinking caffeine is remotely equivalent to using heroin. Unless you’re a heroin addict who wants to make sure that you can claim everyone is as bad off as you were.

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  22. #22 DuWayne
    November 12, 2009

    Mike Olson – (If you are still about)

    You seem to be making a lot of assumptions, based on false equivocations. This is really easy to do when it comes to addiction, because unfortunately there isn’t a single cohesive, coherent clinical definition of addiction. To some degree there never will be, because there are a lot of different types of addiction. Not different addictions based on different substances or behaviors of abuse, mind. The differences are in the motivating factors.

    Someone who shoots heroin every day is not necessarily an addict. Though most of them are, there are also people for whom it is entirely an issue of acute chemical dependence. Get them completely detoxed and they are unlikely to ever touch it again – or pain killers for that matter. Likewise, someone needn’t be using a substance to the extent that they can’t go to work sober to be an addict.

    The most basic and fundamental factor – and unfortunately a very simplistic factor that defines addiction is harm. It is the point that a habit begins to cause substantive harm, that it becomes an addiction. The only difference between an addiction and the sorts of firmly ingrained habits that virtually everyone have, is harm and moreover, the degree of harm. And for the most part, that harm is relative to the preferences of the individual – i.e., if someone is cognizant of and content to accept the damage a substance or habit is inflicting on them, then it cannot be reasonably defined as addiction (there are a host of caveats to that, but this is already looking to be a long comment – I have written quite extensively about this on my own blog, just click the tag “addiction”).

    Addiction is using a substance or substances, or engaging in behaviors that are harmful to oneself and/or those around them, compulsively – without the ability to control oneself. And Mike, that is absolutely a mental illness. No matter what is driving it, whether it be situational, a specific neurological predilection for a particular substance or an unrelated neurological condition, addiction is mental illness. More accurately, it is several distinct mental illnesses that express themselves similarly.

    But here again, I think you are running into definitional issues. Honestly, I don’t blame you – I despise the term mental illness. As someone who has a brain that works rather atypically, I rather take exception to the implication that there is something inherently bad about my brain operating in the manner it does. At the same time, I am thirty-three and finally going through college as a father of two, having completely failed in my first career – largely because my brain works the way it does. For all the positive aspects of my neurological makeup, it has definitively caused a great deal of harm. In no small part, because one aspect of my neurology is a severe dopamine deficiency. Unmedicated, this meant that I was very keen on abusing a great many drugs – not any specific one (except tobacco), I just needed to use something, anything that would help compensate for that. Preferably something speedy enough to slow my brain down, combined with something down enough to moderate and stabilize my moods (otherwise I could end up a manic, semicoherent loon who would be up and going for days at a time).

    I just don’t have a better term to describe it, though I rather like “neurological issues.” Mental health issues is good too, but both are illdefined. Atypical neurochemistry is good too. But the bottom line is, important as it may be, this is a semantic issue and as the terms are generally used, addiction is absolutely a mental illness. We just don’t sit around and try to differentiate according to the wishes and desires of the folks who need help with something mind based. Though some of us are totally down for working out values neutral terminology, to reflect the understanding that with the bad, there is also a lot of good – even when the mental issue in question is addiction.

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