Viewing addiction as a brain disease promotes social injustice
The
view of drug use and drug addiction as a brain disease serves to
perpetuate unrealistic, costly, and discriminatory drug policies, argues
Carl L. Hart.
More
than 25 years ago, I began studying neuroscience because I thought this
approach would uniquely fix the ‘drug problem’. At that time, I
believed that the poverty and crime in the resource-poor community from
which I came was a direct result of drug addiction; so, I reasoned that
if I could cure addiction, especially through neural manipulations, I
could fix the poverty and crime in my community. But, I learned that
while cocaine — and other recreational drugs — temporarily alters the
functioning of specific neurons in the brains of all who ingest the
drug, 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. To date, there has been
no identified biological substrate to differentiate non-addicted persons
from addicted individuals.
The
notion that drug addiction is a brain disease is catchy but empty:
there are virtually no data in humans 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 their symptoms.
We
are nowhere near being able to distinguish the brains of addicted
persons from those of non-addicted individuals. Despite this, 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 (https://addictionresearch.nih.gov/abcd-study)
primarily seeks to gather neuroimaging data to better understand drug
use and addiction among adolescents. It collects genetic information and
measures drug use 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 (for example, employment status, racial discrimination,
neighbourhood characteristics, 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 (for example,
drug-free societies) or focus exclusively on the ‘addicted’
individual's brain as the problem. In both cases, there is neither need
for nor interest in understanding the role of socioeconomic factors in
maintaining drug use or mediating drug addiction.
The
detrimental effects of using law enforcement as a primary means to deal
with drug use are well documented. Millions are arrested annually for
drug possession and the abhorrent practice of racism 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.
An
insidious assumption of the diseased brain theory is that any use of
certain drugs is considered pathological, even the non-problematic,
recreational use that characterizes the experience of the overwhelming
majority who ingest these drugs. For example, in a popular US anti-drug
campaign, it is implied that one hit of methamphetamine is enough to
cause irrevocable damage: http://www.methproject.org/ads/tv/deep-end.html.
In
the 1980s, crack cocaine use was blamed for everything from extreme
violence to high unemployment rates, premature death, and 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 to say in Newsweek (16 June 1986),
“would be to have God redesign the human brain to change the way cocaine
reacts with certain neurons.”
‘Neuro’
remarks made about drugs with no foundation in evidence were
pernicious: 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 US Congress
passed legislation setting penalties that were literally 100 times
harsher for crack than for powder cocaine violations. More than 80% of
those sentenced for crack cocaine offences are black, despite the fact
that the majority of users of the drug are white. Today, many find the
crack/powder 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.
For
their part, the scientific community has virtually ignored the shameful
racial discrimination that occurs in drug law enforcement. The
researchers themselves are overwhelmingly white and do not have to live
with the consequences of their actions. I don't have this luxury. Every
time I look into the faces of my children or go back to the place of my
youth, I am forced to face the decimation that results from the racial
discrimination that is so rampant in the application of drug laws and is
abetted by arguments poorly grounded in scientific evidence.
We
can no longer allow neuro-exaggerations to determine our drug research
funding priorities and directions, shape our views on drugs, nor our
drug policies. The stakes are too high and the human cost is
incalculable.
Author information
Affiliations
Carl L. Hart is the Dirk Ziff Professor and Chair of the Department of Psychology, and Professor in the Department of Psychiatry at Columbia University, Box 120, 1051 Riverside Drive, New York, New York 10032, USA.
- Carl L. Hart
Nenhum comentário:
Postar um comentário