“New gene therapy for smoking kills the pleasure of nicotine” – so reads the headline in yesterday’s LA Times. This brings up an issue that remains a huge thorn in the side of the committed disease theorists: substance use is a purpose driven behavior, bottom line.
The way people treat you when you publicly say that substance users voluntarily choose to use substances for personal enjoyment, you’d think you were denying the holocaust. They maintain that “addicts” can’t control themselves, that a mysterious disease causes them to use, and that there is no rhyme or reason to “addict” behavior. Yet, every proposed pharmacological solution for addiction aims to rob the “addict” of the pleasure provided by the drug. Every single one.
Most of the medicines rob you of pleasure by filling in the receptors where the neurotransmitters triggered by a drug would normally flow to, providing a high. In the case of this proposed nicotine vaccine, it would create antibodies that eat up the active drug before it can even get to your brain, so this is a slightly different strategy. One of the older ones, Antabuse, makes the patient have a violently ill reaction to alcohol. No matter the minor differences, the overarching goal is always the same, rob the user of any pleasure the drug may provide. This strategy’s implicit logic which can’t be ignored is this: if the drug won’t make the user feel good, then they won’t CHOOSE to use it. I’m just gonna repeat that in big bold letters now because it’s so important, and the main point I want people to leave this piece with:
If the drug won’t make the user feel good, then they won’t CHOOSE to use it.
That’s fine, and it works to a point. But people often go back to using their drug of choice when they’re done with the pharmacological treatment. They also tend to use another drug whose effects aren’t blocked by the medicine they’re taking. Or worse, they try to break the barrier constructed by the medicine – taking massively higher than normal doses of their drug in order to get high. And quite commonly, people just stop taking the medicine when they’ve gotten sick of being robbed of that pleasure, wait a few days for it to get out of their system, then go get high. The drug-makers have responded to this by creating new versions of their medicines which can’t be backed out of so easily as a daily pill. These medicines now come in injections that last 30 days, and implants which last for nearly a year! A vaccine which permanently disables someone from feeling the pleasures provided by a particular drug is just the next logical step in this strategy. To boil it down, I might compare it to cutting your hand off to keep yourself from rolling dice.
Now, those disease theorists who are slightly more sophisticated would explain their perceived necessity of these drugs by saying that to an addict, natural rewards can simply no longer compare with the pleasures provided by drugs and alcohol. Is that cynical or what? In plainer language, they’re telling us that “addicts” aren’t capable of enjoying the finer things in life. I think that’s a wrong and disgustingly cynical view of people.
First of all, the science doesn’t support this view or the need for pharmacological treatments. Yes, when someone is committed to repeating a behavior for pleasure, the brain changes, and repeating that behavior for continued pleasure is the “easiest” option. But somehow, people decide to change, and they take up (or devote more time to) other pursuits which bring delayed gratification – and whatever brain changes we thought were responsible for the behavior have disappeared! Countless millions of people have done this, all without pharmacological treatments. And when they have successfully ditched their problematic levels of use, these people will tell you that they’ve just found more important (and thus ultimately more rewarding) things to focus on. So were the brain changes the cause of continued substance use, or did they simply correlate with it? Were these people unable to find reward, pleasure, and happiness in pursuits other than drugs, or were they just not focused on finding happiness elsewhere? This is where it gets tricky and dangerous, and where I began to resent the disease theorists in the recovery culture.
If you teach people that pleasure and happiness are meaningless and have nothing to do with substance use, and further, you teach them that even if they tried they wouldn’t be able to find satisfaction in other activities – well then, they’ll never try to do that. Substance use is a purpose driven behavior. It’s not bad, and people aren’t bad for doing it. However, there are more efficient, durable, and sustainable ways to build happiness in life. If you can provide the information and a forum which allows people to explore and test those options, then they will find them to be more attractive options, and they will choose to move away from problematic levels of substance use. But that’s a lot harder than chopping off someone’s drinking hand.
The image of the drug users being driven by compulsion no matter the misery unleashed in their lives is so ingrained in American culture. I remember being shocked when a friend in college said to me, “People don’t do heroin because it makes them miserable, twitchy & trembly like you see on the TV cop shows. They do heroin because it’s *fun*.”
I’ve recently heard someone on TV claim that recreational drugs activate the same neural circuits that control the feeling of being in love. If that’s so, would these 30-365 day pleasure blocking agents also interfere with the ability to love? Who would be willing to make *that* trade off?