Assignment task: "Many neuroscientists view drug addiction (or substance use disorder) as a brain disease, and this idea is rarely questioned. On the surface, this perspective is appealing, in part because it appears to remove blame from the afflicted individual and offers hope for treatment through chemical manipulations. But a closer look raises concerns. For example, although cocaine and other recreational drugs temporarily alter the functioning of specific neurons in the brains of all who ingest the drugs, the vast majority of users never become addicted. And regarding the relatively small percentage of individuals who do become addicted, co-occurring psychiatric disorders and socioeconomic factors account for a substantial proportion of these addictions. Most important, to date, there has been no identified biological marker to differentiate nonaddicted persons from addicted individuals.
So the notion that drug addiction is a brain disease is appealing, but it is not supported by the evidence: There are virtually no data from human studies indicating that addiction is a disease of the brain, in the way that, for instance, Huntington's or Parkinson's are diseases of the brain. With these illnesses, one can look at the brains of affected individuals and make accurate predictions about the disease involved and the associated symptoms.
Presently, scientist can't distinguish the brains of persons who meet criteria for a substance use disorder from those of individuals who do not. Even so, the "diseased brain" perspective has outsized influence on research funding and direction, as well as on how drug use and addiction are viewed in society. For example, the recently initiated multimillion-dollar Adolescent Brain Cognitive Development longitudinal study seeks primarily to gather neuroimaging data to better understand drug use and addiction among adolescents. It measures drug use, genetic information, and academic achievement but lacks careful consideration of important social factors. Notably, there has never been such an ambitious funding effort focused on psychosocial determinants or consequences (e.g., socioeconomic status, employment status, racial discrimination, neighborhood characteristics, and policing) of drug use or addiction.
This situation contributes to unrealistic, costly, and harmful drug policies. If the real problem with drug addiction, for example, is the interaction between the drug itself and an individual's brain, then the solution to this problem lies in one of two approaches. Either remove the drug from society through policies and law enforcement (e.g., drug-free societies) or focus exclusively on the "addicted" individual's brain as the problem. In either case, there is no need to understand the role of socioeconomic factors in maintaining drug use or mediating drug addiction, nor is there any interest in doing so.
The detrimental effects of using law enforcement as a primary means to deal with drug use are well documented. Millions are arrested each year for simple drug possession, and the abhorrent practice of racial discrimination flourishes in the enforcement of such policies. In the United States, for example, cannabis possession accounts for nearly half of the 1.5 million annual drug arrests, and Blacks are four times more likely to be arrested for cannabis possession than whites, even though both groups use cannabis at similar rates (see Chapter 15).
An implicit and pernicious assumption of the diseased brain theory is that any use of certain drugs (e.g., crack, heroin, and methamphetamine) is considered pathological, even the nonproblematic, recreational use that characterizes the experience of the overwhelming majority who ingest these drugs. For example, in the Meth Project's popular U.S. antidrug campaign, "The Deep End," young people are told that one hit of methamphetamine is enough to cause irrevocable damage .
In the mid1980s, crack cocaine use was blamed for everything from extreme violence to high unemployment rates to premature death to child abandonment. Even more frightening, addiction to the drug was said to occur after only one hit. Drug experts with neuroscience leanings weighed in. "The best way to reduce demand," Yale University psychiatry professor Frank Gawin was quoted as saying, "would be to have God redesign the human brain to change the way cocaine reacts with certain neurons."13
Frank Gawin quoted in Newsweek (June 16, 1986).
"Neuro" remarks made about drugs with no foundation in evidence were insidious: They helped to shape an environment in which there was an unwarranted and unrealistic goal of eliminating certain types of drug use at any cost to marginalized citizens. In 1986, the U.S. Congress passed now-infamous legislation setting penalties that were literally a hundred times harsher for crack than for powder cocaine violations. More than 80 percent of those sentenced for crack cocaine offenses are Black, despite the fact that the majority of users of the drug are white (see Chapter 6). Today, many people find the crack and powder cocaine laws repugnant because they exaggerate the harmful effects of crack and are enforced in a racially discriminatory manner, but few critically examine the role played by the scientific community in propping up the assumptions underlying these laws.
Many in the scientific community have virtually ignored the shameful racial discrimination that occurs in drug law enforcement, abetted by arguments poorly grounded in scientific evidence. This situation illustrates that we cannot ignore psychosocial factors in our narrow pursuit of a neural understanding of drug addiction. Otherwise, we run the risk of facilitating unintended consequences such as racial discrimination and other negative effects."
Review the excerpt in the textbook called Unintended Consequences: Viewing Addiction as a Brain Disease Facilitates Social Injustice. Answer the following questions:
Q1. What does 'drug addiction is a brain disease' mean?
Q2. What is the evidence for and against the idea that addiction is a disease?
Q3. How has diseased brain theory influenced social injustice?
Q4. Then, given your life experiences, provide your opinion about the factors that most influence drug addiction/substance use disorder.