Do drug addicts really lose control of their drug use?
Many drug users certainly feel as if they have no control of their drug use. Many drug users (especially heroin and other opiate users; meth or methamphetamine users; other speed or stimulant users; and crack users) appear as if they can’t control their drug use. However, there is still no scientific proof that they actually cannot control their substance use, and that they are not choosing to take each successive hit of their chosen drug.
One of the core claims of the disease model of addiction is that “addicts” will literally lose control of their substance use upon taking a single dose of their drug of choice. In other words, the first drink or hit is equivalent to knocking down a set of dominos – once the first domino goes down, the rest are guaranteed to follow. It’s said that they lose control and that a chain reaction happens without their consent.
Do drug addicts really lose control of their drug use? No, they do not. In fact, the available scientific research shows the exact opposite. It shows people choosing the behaviors they think will be most satisfying, given their perceived feasible options. For one example of the evidence, listen to the words of Dr Carl Hart PhD, describing some of what he learned in approximately 15 years of research as a neuroscientist at Columbia University:
The more I studied actual drug use in people, the more I became convinced that it was a behavior that was amenable to change like any other…
In one study, we gave methamphetamine addicts a choice between taking a big hit of methamphetamine (50 mg.) or five dollars in cash. They took the drug on about half of the opportunities. But when we increased the amount of money to twenty dollars, they almost never chose the drug. We had gotten similar results with crack cocaine addicts in an earlier study. This told me that the addictive potential of methamphetamine or crack was not what had been previously claimed; their addictiveness wasn’t extraordinary. Our results also demonstrated that addicts can and do make rational decisions…
The bottom line is, that if supposed “addicts” can forego the opportunity to get high when they perceive a more attractive opportunity – then this means that they are choosing – that they are in control – that they are doing what they currently believe is their best feasible option for a positive return (i.e., happiness, pleasure, satisfaction, or whatever you wanna call it).
Dr Hart’s work on drug addiction is extremely similar to a series of experiments done with alcohol in the 60’s and 70’s (these are known as priming dose experiments, because they measure people’s behavior after an initial dose of an intoxicating substance). Some of those studies, such as the work of Nancy K Mello, showed that alcoholics could be paid to refuse the opportunity to drink even while already under the influence, just as Hart’s work showed with crack and meth users. In some other priming dose experiments, hardened alcoholics were given alcohol without their knowledge – and yet they did not proceed to “lose control” and seek out alcohol or report heavy irresistible craving. It’s unlikely that the exact experiments with drugs (slipping someone crack or heroin without their knowledge) will be done today. However, the principle demonstrated in those experiments should also hold true for other intoxicants such as heroin, cocaine, meth, etc. For more information on the experimental scientific evidence pertaining to alcohol and loss of control, see this article: Do Alcoholics Lose Control? The Results of Priming Dose Experiments Say NO.
More data will be added to this page over time as I get the chance to add it, but for now, I wanted to have something up that addresses this basic question. If anyone thinks they have data that proves “loss of control” I encourage them to provide links to it in the comments section. Be forewarned, the fact that the sight of a drug paraphernalia correlates with certain brain activity is not proof of loss of control. If you’re going to present such data, please include a logical argument that demonstrates how control is lost or substance use is “caused” by such brain activity.
what about people with addictive personalites.. or with o.c.d.?? and i suppose people with eating disorders, thats all in their head too???
Where are your references
Lol – is that a real question?
I am an Egyptian consultant psychiatrist and I adopt many of your convictions but since most of the people that I speak to are from the medical community and opposing me so I need to substantiate my talk with evidence as they are always skeptical
I hope you’re not offended
I’m not offended, just a little puzzled. There is a link in the article to the source I quoted – an article written by Dr Carl Hart. There is also mention of researcher Nancy K Mello’s studies, whom you could look up. Then there is another link to a similar article about alcohol on my site where I provide full citations for 9 relevant studies on alcohol, and a book chock full of such research on alcohol. Follow the links, check out the work of the scientists I mentioned, and there you have it.
I’ll add that for a quick concise Journal article refuting some of the major myths about addiction, you should check this out – here is the link: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3644798/ The article is called Addiction and Choice: Theory and New Data, by Gene Heyman PhD.
Here is the APA style citation:
Heyman, G. M. (2013). Addiction and Choice: Theory and New Data. Frontiers in Psychiatry, 4. doi:10.3389/fpsyt.2013.00031
I am currently addicted to heroin. I see those stupid commercials at night pleading that, “Addiction is a disease , and you can’t do it alone…” I have never thought addiction to be a disease. That aside, I did want to comment on the study you referred to most addicts being able to make “rational decisions.” If you put the study in perspective one hit is worth more than five dollars being meth or heroin (I’ve done/paid for both). When you give a meth/heroin addict $20 you are essentially giving them the choice to except one measly little hit or to go score a full bag. That study is completely inconclusive. Did anyone actually see what that twenty dollar bribe was spent on? Just some food for thought.
Thanks for commenting and sharing your perspective. I understand your hesitance with that research. The important point to remember about it is that the disease model of addiction is built on the idea of loss of control, and in more sophisticated explanations the “addict” is portrayed as being unable to plan beyond the here-and-now. That is, they supposedly lack “impulse control”; they can’t make long range decisions; they always sell-out their long-term interests to get high in the moment.
But in Hart’s experiments, they were going to be getting the money a few weeks after the experiment. Even if 2 weeks later they spend all the money on crack, they’ve nonetheless exhibited the ability to forego an immediate gratification for a possibly bigger gratification at a later date. Even though I don’t like the term I’m about to use, they exhibited what everyone would call “impulse control” or “self-control” over their drug use.
Now, I’ve been there, in moments when I hustled up the cash to get several bundles of heroin, and planned to taper myself down with it over the next week – but then ended up using it all in 2 days. It doesn’t mean I lost control or that I was literally unable to do so. It just means I changed my mind, basically saying “fuck it, I just wanna get high/feel good now.” Just because we don’t always make “rational” choices doesn’t mean we can’t. It just means we don’t think making those choices is really worth it now. I thought life without daily heroin use was going to be unbearable – free of that awful daily grind, but nonetheless completely joyless and deprived. But eventually I hit a point where I believed it would be genuinely better in the near-term as well as the long-term, and so I finally stuck to the choice to stay quit. Around 90% of heroin “addicts” do this eventually.
Whether you continue to use heroin or not, I wish you the best.
Steven Slate
I see your point and I think I understand the premise of the argument but I find the 90% of addicts will “eventually” quit on there own to be a bit misleading. Statistically it may be true. If you live long enough and don’t die from overdose the consequences of continued use will eventually bring nearly everybody to quit. The numbers of people currently dying in the so-called opiate epidemic are surely an indication that these new substances are more powerful addictive drugs or perhaps at least more dangerous. It’s not that people will not eventually quit if they live. It’s the level of destruction between now and then or now and the end. This is not to say current typical treatment is effective. I don’t see that. The question would be is there treatment that can reach someone and change the use mindset before they’ve finally had enough and decided by themselves it’s necessary to give it up? I believe in freedom of choice but sometimes it’s a hard thing to watch.
Thanks for the question Mike:
I know that by “treatment” you may just mean “help”, but I have to respond to the idea of a treatment first to be clear. Personally, I don’t believe choices can be “treated” in the sense we think of with addiction, where we say it’s a treatable disease, implying a medical intervention of some kind. I know I might sound nit-picky pointing this out, but I think it really matters. When we say we’re going to treat people for a problem we put them in a passive patient role, where they are the helpless victim of something that the doc or therapist can fix, like a broken leg, removal of tumor, or eradication of infection – and their job is to sit back and let the treatment work it’s magic. I know people will argue that patients aren’t always passive and sometimes have work to do, as in diabetes where you need to monitor your levels, take insulin, and watch your diet. But when the doctor’s orders amount to “don’t do drugs” or “don’t be near drugs” – the “patient” is already getting these orders from everyone else in their life and not following them. The “managing diabetes” analogy doesn’t really fit here either because the doctor never tells you “don’t have diabetes” or “don’t have diabetes symptoms” – management of diabetes is rather indirect – whereas the “management” of addiction or “maintenance of recovery” is direct. Don’t use too much substance, don’t get in situations where there are substances. People get into situations where there are substances because they want to use them. Or the doc might say “take your suboxone every day”, but this isn’t quite like taking insulin every day. If you want to stay quit, you take your suboxone as directed – but suboxone doesn’t make you want to stay quit, or it just keeps withdrawal at bay. When you want to get high, you’ll stop taking the suboxone and let your tolerance go down so you can get a high. Same goes for antabuse, naltrexone, or methadone. Treatment providers are puzzled with how to get people to “comply with treatment” and take their supposed anti-addiction drugs every day. They’ll only do that if they figure out in their own mind that they’d be happier not getting high. There is no treatment that can force that conclusion into someone’s mind.
I know that’s a long answer, but to sum it up, I don’t think there is or ever will be a “treatment” of any kind for addiction. The only legitimate treatments related to addiction are those that treat the other health problems caused by heavy substance use, such as withdrawal syndrome, liver problems, overdose, abscesses from injection, et cetera.
Now, if you’re asking “is there help (not “treatment”) we can give to change the user’s mindset before they’ve finally had enough and decided by themselves it’s necessary to give it up?” my answer is yes, there is help that can be offered, but it’s still on the individual to make their own decisions. You can’t force anyone to change their mind. You could present all the evidence in the world to the to convince them that some conclusion is correct, and they may still not see it the way you do, and thus they won’t change their mind. I’m sure you’ve experienced this out there in other realms of life, arguing with people about science, politics, religion, or whatever.
Nevertheless, you can try, and you might get through to someone. You can give them the facts about drugs, what drugs can and cannot do for you, you can tell them of the possibilities for greater happiness in reducing or quitting drugs, you can tell them of the potential you believe they have in other realms of life and to enjoy their lives with less drugs. That’s essentially what my book The Freedom Model for Addictions is designed to do. And if a person gets this new information and changes their mindset, then they are realizing they’ve “finally had enough.” But the difference with The Freedom Model, is that we try to avoid pushing the idea that it’s “necessary to give it up” or that you “have to quit” because that feels like a loss to people, or deprivation, and leaves them wanting. Instead, we help them to figure out what they “want” which in most cases ends up being to fully quit or reduce their substance use to non-problematic levels. When that’s what you want, it ends up being easy to follow through on, and doesn’t leave you wanting substances or feeling deprived of them.
When I put these facts out there about people getting over their problems without treatment, I’m not trying to say “give up trying to help people.” I’m trying to give confidence to those who feel stuck. To show them that it is not a longshot, and they can get over their problems. They can and most likely will!
Source for alcohol, marijuana, and cocaine stats: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3227547/
Source for prescription drugs stats: http://www.journalofpsychiatricresearch.com/article/S0022-3956(12)00252-X/abstract
This is great news! People are crushed by dire predictions that they’ll be “addicted” for life, but it just isn’t true. Let’s replace fear with confidence in the fact that people can and will change if they try!
I hope this answer helps.
Best,
Steven Slate
Hi
Do you really believe that if I smoke crack without knowing it is crack or shoot cocaine without knowing it is cocaine I am not going to crave for more ?
Thanks.