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Addiction policies should accord with neuroscience, Stanford researchers argue

In "Neuroscience of Need: Understanding the Addicted Mind," an article I wrote for Stanford Medicine magazine a few years ago, I tried to describe the hijacked brain circuitry of addiction:

[A]ll addictive drugs appear to share a rather mysterious property: They’re 'better than the real thing.' Better, that is, than the real things our [brain's] reward circuitry was designed by evolution to reward: food, sleep, sex, friendship, novelty, etc. And better, even, than they were the last time around. At least, it sure seems that way to the addict. ... You crave, seek and use a pernicious drug again and again because you have a memory of it being more wonderful than anything else, and because your brain has been rewired so that, when exposed to anything that reminds you of the drug, you will feel rotten if you don’t get some.

Two crucial sources for my article were behavioral scientist and drug-policy thinker Keith Humphreys, PhD, and neuroscientist and brain addiction-circuitry mapper Rob Malenka, MD, PhD. Recently these two joined forces with two other addiction experts -- psychologist Brian Knutson, PhD, and law professor Robert MacCoun, PhD -- to pen a brief but comprehensive perspective that appears today in Science. A Stanford news release captures its key points.

The quartet's manifesto outlines an approach society ought to consider adopting to counter the thorny and growing societal problem of addiction, whose brain-snatching character hasn't mellowed a bit since I wrote my magazine article.

Far from it: An average of 78 people now die daily in the United States from opioid-drug overdoses alone, the authors note. The simplest way to reduce drug addiction, they write, is to prevent it, by making addictive drugs less available -- especially to young people. Yet, for reasons amply cataloged in the Science piece, the opposite phenomenon is quite visibly the case.

That's too bad. A major takeaway from my exposure to the research findings during my work on "Neuroscience of Need" was this: Addiction, like riding a bike, is a learned behavioral pattern you don't unlearn even if you haven't performed it for decades. Your brain's semi-permanently hot-wired reward system has to be stripped down, reordered, and re-insulated again.

The Stanford experts write:

The widespread practice of treating addiction only with short-term medical 'detoxification' to help addicted patients cope with withdrawal symptoms – a policy reinforced by U.S. health insurance providers – serves only to remove the acute effects of the addictive substance rather than treat the disorder (and may also increase risk of future overdose by inducing loss of tolerance). ... In contrast, contingency management programs which change behavior through the use of immediate, small rewards (e.g., a meal voucher for a negative urine test) have demonstrated impressive efficacy. ... The human brain is more sensitive to swift and certain environment responses to behavior than to distant and probabilistic ones[.]

The best post-addiction prescription -- long-term therapy -- is expensive, but a lot cheaper than imprisonment. Plus, there's something to be said for scientifically validated steps that might restore a person's soul rather than compound the damage to it.

Previously: The two faces of MDMA: Drug of abuse, and promising therapeutic and research tool, Stanford addiction expert: "The country needs to spring into action" on heroin epidemic and Better than the real thing: How drugs hot wire our brains' reward circuitry
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