Researchers say U.S. policies on drugs and addiction could use a dose of neuroscience

Researchers say U.S. policies on drugs and addiction could use a dose of neuroscience
Professor Keith Humphreys is one of the leaders of the Stanford Neuroscience Institute’s Neurochoice Big Idea initiative. Credit: L.A. Cicero

Tens of thousands of Americans die from drug overdoses every year – around 50,000 in 2015 – and the number has been steadily climbing for at least the last decade and a half, according to the National Institute on Drug Abuse. Yet a team of Stanford neuroscientists and legal scholars argues that the nation's drug policies are at times exactly the opposite from what science-based policies would look like.

"Drug policy has never been based on our scientific understanding," said Robert Malenka, a professor of psychiatry and behavioral sciences and a coauthor on the paper. Instead, it is based mostly on culture and economic necessities – and a misguided desire to punish harshly.

The time has come, he and coauthors write June 22 in the journal Science, to do better.

"We have an opioid epidemic that looks like it's going to be deadlier than AIDS, but the criminal justice system handles in almost exactly opposite of what neuroscience and other behavioral sciences would suggest," said Keith Humphreys, a professor of psychiatry and and one of the leaders of the Stanford Neurosciences Institute's Neurochoice Big Idea initiative.

(Not) thinking about the future

A central problem, the authors argue, is that drug use warps the brain's decision-making mechanisms, so that what matters most to a person dealing with addiction is the here and now, not the possibility of a trip up the river a few months or years from today.

"We have relied heavily on the length of a prison term as our primary lever for trying to influence drug use and drug-related crime," said Robert MacCoun, a professor of law. "But such sanction enhancements are psychologically remote and premised on an unrealistic model of rational planning with a long time horizon, which just isn't consistent with how drug users behave."

What might work better, Humphreys said, is smaller, more immediate incentives and punishments – perhaps a meal voucher in exchange for passing a drug test, along with daily monitoring.

The environment in which individuals live matters, too, Humphreys said – especially when that environment pushes alcohol, cigarettes and prescription painkillers hard. Cigarette advertising, for example, works to make smoking seem like a pleasant escape from the grind of daily life. Meanwhile, drug companies' advertising campaigns helped push American doctors to prescribe painkillers at much higher rates than in other countries, a fact that has likely contributed to the country's growing epidemic of opioid addiction.

Pragmatism, not apologetics

The scientists argue that basing policy on science rather than on a desire to punish addicts would improve lives, including victims of drug-related crime.

"To learn that addictive drugs distort the choice process is not the same as showing that addicts are incapable of making choices. Addicts already know full well that their behavior is inappropriate and stigmatized," MacCoun said. "But mostly I think questions of morality distract from very practical questions about what works and what doesn't work to reduce drug-related harm."

And, the researchers say, the costs of current policy are staggering: on average 78 Americans die every day from opioid overdoses.

Basic science for the public good

The new commentary is timed to appear four days before a much-anticipated report from a presidential commission on drug addiction. While it may not have an impact on that particular report, Humphreys and his coauthors say they hope the commentary and the Neurochoice Initiative it is part of will make a difference in a critical area of public policy.

To that end, Neurochoice brings together neuroscientists, psychologists, public scholars and others to tackle drug addiction and find better treatments and policies for dealing with the problem. It has already produced some intriguing results. Professor of Psychology Brian Knutson and colleagues, for example, recently showed that brain scans could help predict which adolescents would initiate excessive use in the future. Those are the kinds of results, the authors write, that might guide better laws and practices in the future.


Explore further

Ohio sues five drugmakers over role in opioid crisis

More information: Brains, environments, and policy responses to addiction. Science (2017). science.sciencemag.org/cgi/doi … 1126/science.aan0655
Journal information: Science

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Jun 23, 2017
Last figure I saw was 30,000 opioid deaths last year. Not 50,000. By comparison, about the same number of people die in car crashes every year; somehow, that's not a crisis.

Meanwhile, prescription drugs kill 250,000 a year, and medical malpractice probably accounts for another 100,000 or so deaths. I don't know how you protect the public from prescription drugs or incompetent doctors, but the "OPIOID CRISIS" is relatively easy to end --- because the black market garbage that is killing people would disappear from the streets overnight if Prohibition were to be repealed and replaced by a neuroscience-based approach.

Junkies need soft drugs, not hard time. Addiction experts have found that most junkies "move on" from addiction after about 10 years: how about looking for ways to shorten the time it takes folks to accomplish that?

Jun 23, 2017
Anonym,

Last figure I saw was 30,000 opioid deaths last year....

...how about looking for ways to shorten the time it takes folks to accomplish that?


The USA consists of 60% of the world's opioid usage, 40% of our food is waste(http://www.fao.or...gs/en/). This is not about numbers for the public or even minimizing effort.

Shortening time from 10 years will hurt and help some. Legalization will kill the hard core junkies quicker. Uptake inhibitors already exist. Burning out circuits quicker is not as good of a solution as awareness.

The USA was never about empowering people's choice. The FDA won't even track their prescriptions. Yet the government is killing people by tracking them, just to see who is at work (http://www.bigger...n.com/).

The ruling class is more concerned about their illusion of control, oppression, and dominance, than sustainment, informed experimentation, and humility before process control.

Jun 23, 2017
End the de-Humanizing War on Drugs. Release all prisoners for drug offenses, expunge said offenses from the records, return or recompense all seized property to rightful parties & legalize all illicit drugs now.

Jun 24, 2017
If people's hearts don't change, all of these methods will ultimately fail.
We have to get back to teaching and living moral lives.


Jun 25, 2017
These neuroscientists apparently don't understand human behavior very well. Ironic, that. The reason these drugs are illegal is to deter people from using them in the first place. And when you make something illegal you need a consequence otherwise what's the point of making it illegal? Contrary to what these self-appointed saviors say, law enforcement has long recognized the need to help addicts get treatment ant there are programs all around the country focusing on treatment over punishment. The harsh prison sentences aren't for users, they're for dealers; the ones trying to hook the next generation of addicts. That's evil and should be severely punished. The rub is that a lot of dealers are also addicts who deal to help pay for their addiction. Sad, but what's even more sad is that they have passed their addiction on to others and spread the misery by peddling drugs. I say punish them.

Jun 25, 2017
aksdad, you don't seem to know too much about the rehab "programs" generally given to users. Yes, they are different from prison. What people don't seem to realize is that, to the punished, they are every bit as dehumanizing, depriving and humiliating as prison. Not to mention the MOST SIGNIFICANT ISSUE: it is often a *felony* conviction--just like dealing. That means you have virtually no good opportunities when you get out. The best you can manage is low level work even if you were doing well before. It's a modern day scarlet letter, and just as asinine. "We'll treat you. But we'll also take away the majority of opportunities from you so that you'll REALLY be in a hard place when you get out." Oh, that's just genius for long-term recovery! As far as the current modes of "treatment," go ahead and google around for recidivism rates. You'll see what we've got isn't working too well.

Jun 25, 2017
End the de-Humanizing War on Drugs.


I upvoted you, SKULLTRAP, but I'm not in 100% agreement. Illegalized marijuana was a political decision, our opiate prohibitions are aimed the people of color, as are the enhanced penalties for crack cocaine. We should have legalized marijuana long ago, organic psychedelics are a legitimate part of several religions, and we could do some across the board easing of access to non-opiate pain care.

Under no circumstances do drugs like cocaine, methamphetamine, etc need to be legal. Things that steal one's volition are always going to be a problem for individuals and societies.

Jun 25, 2017
The harsh prison sentences aren't for users, they're for dealers; the ones trying to hook the next generation of addicts.


You have at most a reading knowledge of how such things work here. That position is barely supportable without factoring in the race and income inequality angle behind the problem.

Jun 25, 2017
That means you have virtually no good opportunities when you get out.


Our incarceration rate is as even bigger joke than our health care system, as difficult as that is to believe. We've lost two generations of predominantly black men and for profit prisons are the 21st century equivalent of slavery. We eliminate it, or it will destroy us as a nation.

Jun 26, 2017
All addictions have a common root in the limbic system. This is basic neuroscience. Putting people in prison for being drug addicts and engaging in addiction behaviors is basically the same as thinking that prison would cure obesity (food addicts), workaholics, gambling addicts, sex addicts, video game addicts, all of which are recognizably idiotic treatment options for those disorders.

Jul 07, 2017
There's a great TedX talk about addiction. The way we treat addicts is not working. Other countries have tried different ways with great success. The talk is by Johann Hari and its called Everything you think you know about addiction is wrong


Jul 10, 2017
"To learn that addictive drugs distort the choice process is not the same as showing that addicts are incapable of making choices. Addicts already know full well that their behavior is inappropriate and stigmatized," MacCoun said. "But mostly I think questions of morality distract from very practical questions about what works and what doesn't work to reduce drug-related harm."

I would completely disagree with this paragraph. Addicts are addicts before they get into trouble, and none (including myself) that I know of, didn't believe their actions were appropriate with no stigma. Then problems come and you recognize you are an addict.

Secondarily, it IS a moral issue, but people don't like to think of them as such. Why do that? You'll only wreck the fun times! Our societial and governmental structures are teaming with industry to push state sponsored syringes, dime bags and tell you you go about your business.

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