Self-Refuting Drug Warriors
Jacob Sullum | April 18, 2008, 7:02pm
A new analysis of data from the National Survey on Drug Use and Health once again confirms a point I emphasize in my book Saying Yes: The vast majority of illegal drug users do not fit the stereotype of addiction and degradation promoted by the government and the news media. Based on data from the 2004, 20005, and 2006 surveys, the Substance Abuse and Mental Health Services Administration (SAMHSA) calculated the percentage of people who became "dependent" on various drugs within two years of trying them. Here are the dependence rates, in ascending order:
Inhalants: 0.9%
Tranquilizers (nonmedical use): 1.2%
Psychedelics: 1.9%
Sedatives (nonmedical use): 2.4%
Painkillers (nonmedical use): 3.1%
Alcohol: 3.2%
Cocaine Powder: 3.7%
Stimulants (nonmedical use): 4.7%
Marijuana: 5.8%
Crack Cocaine: 9.2%
Heroin: 13.4%
In some ways these results track conventional wisdom. Heroin comes out on top, which conforms to traditional thinking if not to more recent scare mongering about crack and methamphetamine, each of which was said to be at least as addictive, if not more so. But even in the case of heroin, a large majority of users were not deemed "dependent," and most (69 percent) had not even used the drug in the previous year. Likewise, crack looks more addictive than cocaine powder, but 76 percent of the people who tried crack were not using it at all a year later, quite a feat with a drug that's said to be instantly addictive. The comparable rate for cocaine powder was 58 percent, which could mean that a) people find it more appealing than crack, b) people find it easier to integrate into their lives because the experience is less intense, or c) people find it more appealing because it's easier to integrate into their lives. I think most people would be surprised to see that "stimulants," which included methamphetamine, rate lower on this addiction scale than heroin, crack, and even marijuana, and that narcotic painkillers, described as overwhelming and irresistible in press coverage of the OxyContin "epidemic," look no more addictive than alcohol.
A few notes of caution:
1. SAMHSA measures drug dependence through questions based on the American Psychiatric Association's diagnostic criteria, which require three or more of seven indicators: 1) tolerance, 2)withdrawal, 3) taking the drug in larger amounts or over a longer period than intended, 4) a persistent desire or unsuccessful efforts to cut back, 5) a lot of time spent getting, using, or recovering from the effects of the drug, 6) disruption of important social occupational, or recreational activities, and 7) persistent use despite serious drug-related physical or psychological problems. To qualify for the label, a patient is supposed to be suffering from a "maladaptive pattern of substance use" that leads to "clinically significant impairment or distress," which is difficult to assess at a distance through a survey. But the major line of criticism I've seen indicates that, if anything, applying the "clinically significant" criterion would generate lower rates of substance dependence.
2. This particular analysis covers just a few years, and serious drug problems may take longer to develop (although that's certainly not the impression left by the government's anti-drug propaganda). Studies covering longer periods, such as the National Comorbidity Survey (which I cite in my book), do find higher addiction rates. But they still indicate that addiction is not a typical result of drug use.
3. It's risky to assume that the addiction rate associated with a substance has to do with its inherent properties, as opposed to the sort of people who like to use it. It seems plausible that people who are attracted to an extreme, notorious practice like heroin injection, for example, are different from people who aren't in ways (tastes, preferences, personality traits, circumstances) that affect their likelihood of using the drug heavily.
[via the Drug War Chronicle]
Fusion | April 19, 2008, 1:29pm | #
As a Neuroscientist, and addiction researcher, I find the list to be interesting. The very idea that Psychadelics are addictive is amusing. What evidence, and how is "addicted" criteria met in this study?
Heroin, Meth, Cocaine have high risk for addiction. Pain killers as well. The question is susceptability...as some people have alluded toward. Different populations, genetics, environmental factors can increase the risk of a one time or a recreational user to become addicted. Funny enough, even in animal studies, with inbred rodent strains, mice and rats have genetic differences that will differentiate their ability to work for a drug like cocaine, heroin, or meth.
The rates of use, and economic impact of drug and alcohol abuse costs cooperate America an estimated 100 billion per year, in increased health care costs, loss in productivity, etc. But given that information, what other "addictions" cost society. Drugs are a window to that kind of behavior.
Figuring out how these drugs work, and their risk is a valuable commodity, and teaches us about motivated behavior. Understanding both the sociological and neuropsychopharmacological mechanisms for drug seeking is paramount to understand how people make risky decisions. Much of what we learn about drug addiction relates to gambling, and other behaviors.
In any case, in animal models, drugs like Marijauna are very difficult to use in a "addiction" model. Animals just won't work as hard for that kind of drug as they will for Morphine or Heroin. The problem is that these lists group all the drugs together as if they were equal, and as if all the population was at the same risk: that simply isn't the case.
dan umanoff, m.d. | April 19, 2008, 5:22pm | #
Re: Self-Refuting Drug Warriors, http://reason.com/blog/show/126086.html
Sullum has wonderfully discovered one of the secrets that I have known and written about for 16 years that if used wisely can finally end the drug war and all its ramifications. An old article of mine that discusses this is, “The Drug War War,” at: http://www.nvo.com/hypoism/articlesbyandforhypoicspage2/
Sullum’s article states: "A new analysis of data from the National Survey on Drug Use and Health once again confirms a point I emphasize in my book, “Saying Yes”: The vast majority of illegal drug users do not fit the stereotype of addiction and degradation promoted by the government and the news media." The article concludes, "It's risky to assume that the addiction rate associated with a substance has to do with its inherent properties, as opposed to the sort of people who like to use it. It seems plausible that people who are attracted to an extreme, notorious practice like heroin injection, for example, are different from people who aren't in ways (tastes, preferences, personality traits, circumstances) that affect their likelihood of using the drug heavily."
So, what Sullum is saying is: 1) that the government has disproved their own contention and theory that the use of addictive drugs is the cause of drug addiction [the hijacked brain hypothesis] and 2) that there is something about those users who do get addicted that is different from those who don't. [What Sullum thinks is the difference is wrong however. We will get to that in a minute.]
Let me rationally translate this into something meaningful and useful. These two conclusions are correct and critically important in changing our county's thinking and policies about addictions. Currently, our country's "drug" laws and policies are based on the addiction theory known as the hijacked brain hypothesis (HBH), long believed but only first codified in Leshner's article: Leshner A.: Addiction is a Brain Disease, and it Matters, Science; 278, 45-70, 10/3/97 . What this theory states is that drug use is a conscious choice, voluntary (a moral choice), and then the drug changes the brain into an addicted brain and that this change (addiction) is now a brain disease. Thus, because addiction is defined as harmful to society, like theft and murder, drug addiction is an immoral behavior requiring both government protection (criminalization of drugs) and punishment of drug users and addicts (criminalization of users and addicts). All aspects of the drug war are an outgrowth of this theory. The only problem, which Sullum has discovered, is that the HBH is scientifically wrong, and, if the HBH is wrong then the policies based on it are wrong, something we all know. But now we know why.
The true science of addiction and addiction causation is quite different from the HBH, which, it turns out, is a deliberate governmental lie, a major scandal. This science is reviewed in my book, Hypoic’s Handbook, and web papers, http://www.nvo.com/hypoism/hypoismhypothesis/ and http://www.nvo.com/hypoism/thehypoismaddictionhypothesis/. Within the first paper is embedded a link to Hiroi’s paper also reviewing this science up to 2005. You can thus read that paper without having to go to the library. [Hiroi uses the term “plasticity theory” rather than “HBH.” They’re the same thing.] Hiroi concludes his review of addiction causation with: “A majority of substance users do not develop addiction to nicotine, alcohol, or opiates. Currently available plasticity-based models (model 1. – the HBH) of addiction do not adequately account for the limited prevalence of addiction among chronic substance users and the presence of pre-existing, comorbid traits. The genetic model (Model 2) of addiction predicts that addiction is more likely to develop after initial substance use in individuals with genetic susceptibility. Model 2 [the genetic model] highlights the need for a new direction in addiction research as well as new treatment strategies.” -- Exactly what I’ve been saying for 16 years and for exactly the same reason.
What all this science shows is that the difference between people who get addicted and those who don’t is their genetics, not voluntary choices, tastes, preferences, personality traits, and circumstances. Thus, it is genetics that causes addictions and the disease is not the addiction but the actual genetic differences (which haven’t yet been specifically delineated). I have called this genetic disease Hypoism because it is a disease of low (hypo) reward system activity and addictors, drugs and addictive behaviors, all raise this activity. It turns out that the use of addictive drugs and behaviors in people who ultimately get addicted is genetically mediated (not morally mediated), involuntary and unconscious, the complete opposite of the HBH. It also turns out that policies like the drug war can’t work on such a disease. That’s why they don’t work. Completely different policies are required to prevent and deal with addictions under the Hypoism paradigm than under the HBH. These are all discussed in my book. Many of them are exactly what the anti-drug warriors want but for the right reason.
As Sullum’s article implies but doesn’t quite say because he’s unaware of the actual answer, the genetics, we need to change addiction paradigms from the HBH to Hypoism. Then the most effective and humane policies to combat addiction will follow as they do whenever the correct theory replaces the wrong theory. These changes require changing the leadership and people pushing the misinterpretation of the real science and the pseudoscience of the HBH starting at the top with Nora Volkow, the Bush appointed chief of NIDA, appointed specifically to maintain the drug war. Under a new president who values valid science over ideology and mythology all this is possible, but the people need to know about it as well as demand it.
Alexander DeLuca | April 30, 2008, 4:33pm | #
Thank you, Mr. Sullum, for an interesting article. My comments:
http://doctordeluca.com/wordpress/index.php/archive/prescription-lies/374/
Big Prescription Drug Lies; Alex DeLuca; War on Doctors/Pain Crisis blog of the Pain Relief Network; 2008-04-27.
Excerpt:
Sullum, referring to an analysis of 2004-2006 survey data by the government Substance Abuse and Mental Health Services Administration (SAMHSA), notes that the calculated rates of “dependence” or addiction (tolerance plus continued use despite adverse consequences) within two years of using various substances are very low. For example, SAMHSA estimates that 3.1% of people who ‘nonmedically use’ prescription painkillers show evidence of addiction, 96.9% do not. For comparison, the two-year addiction rate estimate for alcohol is 3.2%, and for cannabis 5.8%
Huh? So, according to the U.S. government’s best scientific guess, cannabis is more addictive than either alcohol or opioid analgesics like morphine and OxyContin? How much did this un-parse-able nonsense cost us? [Some 18 BILLION dollars a year funnel through the drug czar (ONDCP) to fund the drug war including the academics in NIDA and SAMHSA]
So why, with the drug war money flowing like water for decades, is the scientific research so incredibly crude? As I try to explain in an interview done earlier this year with CEI (see raw footage: Part 6: Reign of Terror - Let the Pain In), if the Government really cared so much about the children, wouldn’t they have found a way to study them? All this money for the drug war including funds for substance abuse research (NIDA and SAMHSA), and all we get is survey data? Not one lousy prospective, longitudinal study that would tell us exactly what happened to the 25% of adolescent “prescription drug abusers” who only used a few times, or the majority who used 10 times or less? Please.
In fact the U.S. Govt doesn’t give a rats ass about either drug abuse or drug addiction. Don’t take my word for it, read the yearly White House Drug Strategy. They are obsessed by drug USE, and that is all they measure - raw use. This simply is not sufficient data upon which to make rational public policy. GIGO - Garbage In, Garbage Out.
I highly recommend Scherlen and Robinson, “Lies, Damned Lies, and Drug War Statistics,” published in 2007, if you are at all confused by the yawning chasm between the endless prescription drug abuse propaganda and the data the Govt actually bothers to collect. Jacob Sullum’s Saying Yes is likewise a demystifying experience.
Finally, Dr. William Hurwitz did a far more sophisticated analysis of a wider array of government databases, using only his brain and the internet and no tax dollars, which was published in 2005 (while he was in federal detention for drug trafficking) in the journal Pain Medicine entitled, “The Challenge of Prescription Drug Misuse.”
Just a snippet from that paper:
"Most individuals who engage in illicit use of pain relievers do so infrequently… As noted in Table 7, slightly fewer than one quarter of those reporting use in the prior year used on only 1 or 2 days. The majority (52.4%) had used these medications on 10 days or fewer in the prior year [supporting] the proposition that mere exposure does not inevitably lead to abuse and dependence. It also suggests the informal and opportunistic… pattern of most youthful drug use (Table 7)."
http://www.doctordeluca.com/Library/WOD/ChallengePDA-Hurwitz05.htm
Apologies for the length of this Comment.
..alex...
