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A central theme that I’ve been teaching in my courses on drug addiction for the past 30 years is that “drug addiction is an equally opportunity affliction.” Unfortunately, this is ‘news’ to too many of my advanced undergraduate psychology students. After just a few weeks of examining the diversity of case studies and then provided with a simple model that unifies the many ‘paths to addiction’ to a single common ‘cause,’ students become excited about the ‘recent progress’ in understanding addiction and fully expect that neuroscientists will find ‘the cure’ in short order. That is, now having recognized what really drives addiction, shouldn’t scientists be able to quickly resolve this disorder which extracts such a horrific toll on the individual, on their friends and families, and on society?
The message is what we (i.e., basic scientists) have known for years, but popular media, many clinicians, and even too many misguided drug-addiction specialists have managed to keep the pond muddied by stirring up the waters with popular discourse and dramatic portrayals played out in endless psychodrama that captivates audiences every time across time. In my primary drug addiction course alone I’ve taught nearly 3,000 400-level students during the past 26 years at the University at Buffalo. Surely there should be a multiplicative effect of my training as they go out and spread-the-word as the next generation physicians, clinical psychologists, counselors, sociologists, and even politicians. And there’s the scores of other professors just like me, some teaching this simple theme even longer. But at last, popular misconceptions like superstitions are just too damn hard to kill off. And “today’s insight” will probably remain a “new discovery” for another 25 years as this professor retires and hopefully the next one caries the torch educating and enlightening thousands more during his/her tenure as a university professor. The more things change, the more they stay the same.
The psychobiological model (Bozarth, 1990) that I teach is rather simple; it’s based largely on what is termed the “exposure model of addiction.” Basically, exposure to an addictive substance and the subsequent effect on brain reward and motivation pathways leads to addiction for many people. The varieties of personalities and subcultures that become addicted is also a product of exposure but with the added feature of psychosocial factors which govern such variables as (1) who has access to the drug, (2) who will experiment with the drug, (3) the cost and purity of the drug, (4) which drug or drugs are popular and how are they administered (e.g., “crack” cocaine is probably more addictive in some respects than is powered cocaine because of the routes they are administered despite being two forms of the same active chemical), and (5) who will find sufficient extrinsic rewards in the culture of their drug-taking behavior (e.g., peers who encourage actual drug taking and its ancillary behaviors) and thus continue their drug-taking behavior long enough for the critical neuroadaptive effects to occur which are ultimately responsible for an addiction. This is where the psychological and sociological variables exert an important influence on who is and is not likely to ultimately become an addict—during the early acquisition stage of developing an addiction. There is plenty of room for popular psychosocial and cultural variables to play a role in addiction and to present cyclic variations in “types” of people who become addicts; the role is just much different that commonly perceived. There are also high-risk groups, some genetically predisposed to experience an exceptionally strong motivating effect from their early drug-use experience and there are co-morbid disorders which may introduce a variety of secondary influences on the drug’s pharmacological effects (e.g., ADHD?, psychological depression?). Nonetheless, the “exposure model” provides a point of convergence for the sundry personalities and subcultures that find the allure of the drug irresistible. The drug is guilty; the addict makes one critical mistake—they sustain their initial use of the ‘wrong’ drug sufficiently long for the neurochemical sequel to develop which leads to addiction.
The popular media, from talk shows to Hollywood movies, will probably never get on the page and portray the real story behind addiction. They will continue to promulgate the popular myths about addiction finding better dramatic material in the cases that admittedly have an interesting story to tell about why they began their illicit substance use, while obscuring the fact that it wasn’t actually the perverted “Uncle Albert” but the drug which is the responsible agent for the addiction. The truth simply doesn’t make a good story. Mary sexually abused by her grandfather, Tom bullied as a child, Nancy stressed out by her failed sex-change surgery are much more entertaining to watch and read about, and they elicit much more empathy from viewers who can relate to various aspects of the anguish that leads to their addiction. Watching young people experiencing the intense rush produced by “crack” cocaine, bouncing from stranger to stranger on the street looking for money for the next fix to feed their cocaine craving has the home audience chanting in unison “they get what they deserve” and then quickly turning to another program. The market writes the message.
During Alan Leshner‘s tenure as director of the National Institute on Drug Abuse (1994-2001), “addiction is a brain disease” became the mantra of the Institute. Whether it’s a “disease, disorder, or syndrome” may be debatable, but it’s certainly a “brain” something unless one wishes to accept pixie dust as the mechanism behind drives and motivations, lusts and desires. The “patterns” are easy to explain—simply examine the psychological and social-cultural variables that initiate and sustain the period of early drug-use; there your personality types, sociological sub-groups and other patterns will emerge, based on who tries the drug not on why they try the drug, no requisite personality types or pixie dust required. The ‘chemicals’ in the drug interact with the ‘chemicals’ of the brain—it’s that simple.
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