MY LORD –
On 18th June 1971, Richard Nixon, the president of the United States declared the War on Drugs. Today, the US alone spends $51bilion every year on that endeavour, with over a quarter of a million dollars already spent since I started my summation. In summer 2016, we will be reaching almost 50 years of that war, and there is still no victory on the horizon.
RELATES TO CASE: The House Believes That Current Addiction Model Is Invalid
The case of addiction and drug rehabilitation is indeed very complex: it entails a mixture of public health policies, political doctrines, social programmes and pharmacological approaches. It projects its influence over many areas of life: from fighting drug dealers in local school through another Pyrrhus’ victory over a drug cartel, new Governmental policies aiming to replace previous failing programmes, and finally to international conflicts in Afganistan, Colombia or Honduras.
Indeed, our Western Civilization fights the drugs, and many other addictions, with a success rate somewhat similar to Don Kichote or Sisyphus.
Recent evidence-based data from American Institute on Drug Abuse indicate that up to 6 out of every 10 drug addicts will come back to square one, regardless of countless options of treatment.
There is also no significant difference in 5 years’ drug abstinence in any of the offered modalities of treatment. You can force someone onto a bed and put methadone in their veins, confine them to a residential home, monitor on the outpatient basis and offer “drug-free” environment.
It does not matter. They will go back into their addiction after all.
The only thing that is different is the cost/benefit analysis. Alas, letting people go back home cost less per day than keeping them in a specialised hospital unit. At the end of the day, why pay more if the result will still be miserable?
MY LORD – I shall not attempt to solve all the problems of the world. I shall not even attempt to solve the Gordian knot of a multitude of issues interweaved in the War on Drugs.
I shall, however, put it before the House that the underlying definition of addiction is a wretched causa efficiens of this misguided approach.
In my speech, I shall present to you, in short argumentation, why the current model of addiction is invalid and what evidence is available to back my case. I shall refrain from indulging in statistical and numerical divagations; my argument will be based on logic and merit, with a short and succinct evidentiary support.
My learned friends on the opposite may wish to contest my numbers and analysis, but they will by no means be able to question the substance of my argument.
The House will be aware that a substantial number of publications, from basic science to societal epidemiology, come off the press every week. Their reasoning, however, suffers from a fundamental flaw that I shall now explore.
Ex turpi causa non oritur actio
1. Rats in cages : The view from Rat Park
Many of the experiments on rats are conducted in a similar manner. The animals live in “Skinner Boxes”, where they can get small portions of food upon pushing a lever and drink water from a tank provided. Scientists can alter this setting by introducing electrical current under the cage for “punishment” stimulation or by adding tanks or injections with different substances.
The experimental studies of the neurobiology of addiction are designed in that the rats have two options: water tank and a tank with an addictive drug (e.g. with heroin). Over time, what happens is that rats tend to access the heroin tank more, becoming “addicted” to that substance. Finally, they can die from overdose and suffer all the conventional addict symptoms (e.g. withdrawal syndrome).
Exibit 1 Courtesy of http://jackiewhiting.net/
This model has been used to study more sophisticated hypotheses, testing drugs for withdrawal syndrome, addiction resistance, adaptation and genetic factors that can influence all of the above.
Au contraire stood Bruce Alexander, a professor of psychology, who decided to explore a rather unorthodox approach:
He built a “Rat Park” environment, where rats could access all the joys life can afford: plenty of space to play, see each other, socialise, have sex, relax and spend time on favourite activities.
Exhibit 2 – “Aerial View” of Rat Park, North Wing
Exhibit 3 – Some [rats] who Prefer the Rat Race
Exhibit 4 – [rats] Just Hanging Out
(figures & descriptions provided courtesy of Bruce Alexander: The View from The Rat Park )
The Rat Park was equipped with just the same tanks of morphine and water. However, the results were somewhat astonishing: rats exhibited no preference for morphine intake and were significantly disengaged with this addictive tank, compared to their caged colleagues (see graph below).
Why the Rat Park rats were not convinced to indulge in morphine? My learned colleagues have elaborated on the “reward pathway” and how different elements in the brain are stimulated when the substance is ingested.
Whilst this holds true, rats were still enjoying each other’s companionship and were more swayed towards the Rat Park attractions than to the neurobiological reward of morphine.
If my learned colleagues’ theory were true, the pharmacological addiction should have more power over the joys of the Park. It should have elicited carvings towards the drug, severe psychotic phenomena, all driving the rats to get more and more morphine.
It was not the case, and the addiction in the caged animals was not because they liked the morphine so much. It was because they had no alternative.
(The Globalisation of Addiction: A study in poverty of the spirit, Oxford University Press, 2008)
MY LORD – ADDICTION is not the chemicals in the tank. ADDICTION is the cage.
2. Why are hospitals not creating drug addicts on a mass scale?
The House will be aware that many emergency treatments, orthopaedics surgeries and even basic perioperative treatment involve addictive substances like diamorphine. According to the conventional addiction theory, patients under the i.v. administration of these drugs should become addicted to them and turn into addicts after discharge.
Does it mean that many people going home after hip replacement become socially excluded drug abusers?
Of course not.
Although textbooks of anaesthesia are full of indications of pain treatment for addicts and people who may have become “resistant” towards certain analgesia, they do not feature massive statistics of post-op referrals to addiction clinics for old ladies with arthroplasty.
And whilst self-perceived fear of becoming addicted to those substances not only scare patients and make them refuse analgesia for e.g. operations and cancer treatment, the sheer fear of becoming addicted, significantly increases the period of post-op pain recovery.
3. Why after War in Vietnam, veterans didn’t become drug addicts?
At the time, there was a public fear that the soldiers coming back from the Far East will become a substantial social problem. According to the conventional addiction definition, after repeated exposure to heroin and frequent stimulation of addiction neurological pathways, including psychological cravings for the drug during the war, such attitude will be sustained after repatriation.
Robinson and colleagues followed up a generalizable sample of 495 men, using self-reported drug usage and urine analysis. At the time of departure, 97% used some kind of addictive drug
However, in the follow-up only 0.7% tested positive in urine sample (2% by interview) in the general sample and 8%, 2.4% respectively in the drug positive at the time of departure sample.
This discrepancy is impossible to be explained by the theory of the opposite side.
Indeed, these soldiers came back to their families, jobs, communities and life roles that they had enjoyed before deployment. The equivalent of their Rat Parks were their own environments: it is easy to fall into drug addiction whilst living under constant stress and fear of death in the Vietnam jungle, but it is not necessary when life provides more enjoyable alternatives.
4. Inefficiency of the current policies – solving the problem
To finalise my summation, I shall attempt to put my argument into a modern perspective. Our current addiction rehabilitation system focuses on persecution and crime fighting. Approximately 64.9% of the UK 2010 drug-related expenditure went for public order and safety.
- By criminalising the drug users and putting constraints on drug imports, we make it extremely profitable for drug dealers to sell relatively cheap commodity (e.g. opium) at massive prices, thus making the business lucrative for criminals and putting dealers in a situation whereby they need to deal more drugs to afford more drugs for their own purpose;
- We make it harder for drug offenders to get a job;
- We put restrictions on their benefits and social housing provision;
- We isolate them in distant rehabilitation centres, often overcrowding them in one place for ease of administration;
MY LORD – I suggest we need to change our thinking. It is high time we alter our model of addiction understanding and accept that the substance abuse arises from the lack of alternative, not a neurochemical pathway in ventral tegmental area. We should restructure our drug prevention system to focus on creating the environment for recovery and not on persecuting the diseased.
MY LORD – I move that we start treating the cage, not the chemical in the tank. Let’s end the war on the problem and start the war for the solution.
AND I BEG THIS MOTION TO THE HOUSE.