The Rationality of Addiction

Drug addicts and substance abusers would hardly come to mind as rational or reasonable individuals. Yet an interesting new study discussed in the New York Times sheds light on the very complex nature of addiction, one that challenges the popular caricature of drug abusers as voracious consumers enslaved at all costs to a particular high.

Dr. Hart recruited addicts by advertising in The Village Voice, offering them a chance to make $950 while smoking crack made from pharmaceutical-grade cocaine. Most of the respondents, like the addicts he knew growing up in Miami, were black men from low-income neighborhoods. To participate, they had to live in a hospital ward for several weeks during the experiment.

At the start of each day, as researchers watched behind a one-way mirror, a nurse would place a certain amount of crack in a pipe — the dose varied daily — and light it. While smoking, the participant was blindfolded so he couldn’t see the size of that day’s dose.

Then, after that sample of crack to start the day, each participant would be offered more opportunities during the day to smoke the same dose of crack. But each time the offer was made, the participants could also opt for a different reward that they could collect when they eventually left the hospital. Sometimes the reward was $5 in cash, and sometimes it was a $5 voucher for merchandise at a store.

When the dose of crack was fairly high, the subject would typically choose to keep smoking crack during the day. But when the dose was smaller, he was more likely to pass it up for the $5 in cash or voucher.

“They didn’t fit the caricature of the drug addict who can’t stop once he gets a taste,” Dr. Hart said. “When they were given an alternative to crack, they made rational economic decisions.”

When methamphetamine replaced crack as the great drug scourge in the United States, Dr. Hart brought meth addicts into his laboratory for similar experiments — and the results showed similarly rational decisions. He also found that when he raised the alternative reward to $20, every single addict, of meth and crack alike, chose the cash. They knew they wouldn’t receive it until the experiment ended weeks later, but they were still willing to pass up an immediate high.

So if biological and psychological addiction aren’t as potent as it seems to be…what accounts for all the addicts? As with most social and public health issues, the origins are multidimensional:

“There seemed to be at least as many — if not more — cases in which illicit drugs played little or no role than were there situations in which their pharmacological effects seemed to matter,” writes Dr. Hart, now 46. Crack and meth may be especially troublesome in some poor neighborhoods and rural areas, but not because the drugs themselves are so potent.

“If you’re living in a poor neighborhood deprived of options, there’s a certain rationality to keep taking a drug that will give you some temporary pleasure,” Dr. Hart said in an interview, arguing that the caricature of enslaved crack addicts comes from a misinterpretation of the famous rat experiments.

“The key factor is the environment, whether you’re talking about humans or rats,” Dr. Hart said. “The rats that keep pressing the lever for cocaine are the ones who are stressed out because they’ve been raised in solitary conditions and have no other options. But when you enrich their environment, and give them access to sweets and let them play with other rats, they stop pressing the lever.”

So once again, we find evidence that negative material conditions — poverty and inequality — play a major role in yet another social ill. It seems so deceptively easy: reduce poverty and improve social environment (usually through the former), and everything else falls into place for the most part. In that case…

…why do we keep focusing so much on specific drugs? One reason is convenience: It’s much simpler for politicians and journalists to focus on the evils of a drug than to grapple with the underlying social problems. But Dr. Hart also puts some of the blame on scientists.

“Eighty to 90 percent of people are not negatively affected by drugs, but in the scientific literature nearly 100 percent of the reports are negative,” Dr. Hart said. “There’s a skewed focus on pathology. We scientists know that we get more money if we keep telling Congress that we’re solving this terrible problem. We’ve played a less than honorable role in the war on drugs.”

Indeed, there are too many entrenched interests that have a lot to gain from the ever-more costly crusade on drugs — from the private prison industry, to moralizing religious fundamentalists, among others. As studies like these continue to mount, and as the social and economic liabilities of this hamfisted approach build up as well, I can only hope we take a more humane and sensible approach to what is ultimately a socioeconomic and public health problem.

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