Thursday, July 26, 2012

My Brain Made Me Do It


As a college student deep into my studies, I have developed a dependency on a warm, slightly sweetened morning cup of coffee. I begin each day (or sometimes each afternoon) with a mug full of the deep brown nectar, with its bold, slow roasted flavor. I suppose I could quit any time I want, right? You know, I could put the cup down and be the same. Maybe I would have a harder time getting started in the morning or be less productive at work. It might be a little more challenging to stay awake on my drive to campus. Maybe I’ll go to bed a little earlier and put off my assignments for another day. On second thought, maybe I’ll stick to my coffee. I don’t think I could do much without it.
Original Image from Americannonfiction.com

With the knowledge that I am far from being the only one with this compulsion, I want to open the discussion on addiction and responsibility. Getting started on ‘something,’ such as drugs, gambling--some are now suggesting even the Internet--is generally considered voluntary. I chose to start drinking coffee, knowing it would give me the extra boost to push through another hour of studying during those late library nights. My body liked the boost, my brain loved it and it has helped me get through school. Initially, coffee turned me into Super Student, the boy who could perform astounding feats of academic performance with the aid of two sugar packets and a shot of hazelnut flavoring. Now, as I approach my senior year, things have changed. As I mentioned before, I need, and I’ll use that term need carefully, a caffeine boost to even reach my baseline.

I don’t think anyone would say I’m a bad person, or morally weak for being hooked on caffeine, but it certainly is a dependency. People seemingly can become addicted to anything, and they do. Common addictions are to alcohol, gambling and illegal substances. Suddenly, when faced with these vices, the situation takes a serious turn. Addicts will go to extensive measures to achieve satisfaction. We have all heard stories of addicts stealing from friends and family to pay for their next fix. There is no doubt that the behavior of addicts can be destructive to themselves and those around them. While we may be prone to feel anger and resentment towards addicts, it is also important to understand the nature of addiction.

Original image from Thoughtbroadcast.com
Dr. Steven Hyman, current Director of the Broad Institute Stanley Center for Psychiatric Research (also the former provost of Harvard and former director of the National Institutes of Mental Health), sat down with a few members of the Neuroethics Program to talk about addiction. He gave a brief explanation of the neuroscience behind compulsion and addiction. “We now recognize the compulsion that is related to drug use involves brain reward circuits, and the neurotransmitter dopamine,” said Dr. Hyman. He explained that failures of the prefrontal cortex to exert top down negative control on these behaviors make addicts susceptible to compulsive feelings.


To learn more about how this worked, I looked up what the CDC had to say about addiction. In short, your brain is wired to respond to things it believes will aid in survival e.g., food and sex. Pleasurable feelings associated with an action make us more prone to repeat that action. That seems intuitive, right? Drugs, as well as other addictive substances, make use of this system. Dopamine, the main neurotransmitter for regulating pleasure, is released at levels 2 to 10 times than normal during drug use. This dopamine rush is responsible for the intense, euphoric ‘high’ experienced by drug users. Over time, the brain makes adjustments and produces less dopamine than was produced when it was initially exposed to the drug. It takes more of the drug to feel normal and that’s when it becomes dangerous. Addicts fall into a downward spiral of trying to track down more and more of their drug.

But does this make them bad people? Do we charge them with being morally weak and feeble minded? A lot has changed with our understanding of addiction in the last century. Researchers have come to agree that addiction is a brain disease (or disorder). This moves away from the view of addiction as a moral failure and supports the view that addicts should be treated as any other ‘diseased’ individual. Our view of addicts has changed, as control shifts from the addict’s ‘will’ to the addict’s genes. The big question is who, or what, is responsible for an addict’s behavior when their addiction pushes them to break the law? I want to know who bears the responsibility when a drug addict’s behavior incurs a burden on society. What should the court rule when the accused claims, “My brain made me do it?”

Understanding Addicts

It is generally accepted that genetics play an influential role in addiction. Family history of addiction as well as other genetic predispositions may determine an individual’s vulnerability to addiction. Scientists have now come to understand how these genes can affect a person’s reward system. Specifically, when an addict comes into contact with his/her substance of abuse (or whatever it may be) his/her reward system circuitry becomes over stimulated. Over time, there is an actual change in the circuitry of the brain as a direct result of the addiction process, says Dr. Hyman.

There is a need to adjust the law to acknowledge this development in our understanding of addiction. Dr. Hyman asks, “So if addiction is a disease, what’s the justification for punishment?” He continued to explain that punishment has different goals. He first mentions deterrence, which serves to set an example, such that others know not to do it. Next, Dr. Hyman discussed incapacitation, which limits the individual’s ability to commit future crimes and removing them from society. He mentions that modern society has over used incarceration to the point where prisons are full of people that haven’t committed violent crimes.

There are a lot of questions on how to treat addicts, as each case is unique and presents unique challenges. Addicts have come to value drugs, or whatever their vice is, over all other things. Government mandated punishment might help some change their priorities, for others, punishment may be totally ineffective. Additionally, shorter term or regular rehabilitative medical treatment might be a better option than the alternative of lifelong punishment. However, the threat of punishment holds some power; there is a societal pressure to obey the law. Dr. Hyman says, “I’m not against all punishment, because punishment or threat of punishment can be a tool.”

Addiction and the Effects on Society

The game gets more serious when you slide along the scale of addiction, away from “wasting your time” to now becoming a threat to society. There are cases of addiction where the addict has become dangerous. Under such circumstances, punishment or incarceration may be the appropriate course of action. It is easy to agree that individuals should not be allowed to harm others. However, how should addicts (under the influence or experiencing withdrawal) be punished or are addicts even responsible for their crimes? Should dangerous addicts be lumped together with sociopaths and over dangerously mentally disabled individuals? There is no clear easy answer to these questions.

It is important to recognize that cases of addiction that do not lead to crimes and physical violence still effect society. Consider the case when a compulsive cigarette smoker develops lung cancer. Many would see that as a self-afflicted condition, considering that the individual initially chose to smoke. That individual in turn takes time, attention and medical resources that may have been spent on someone else. They are using more healthcare resources as they combat the effects of smoking. While these addicts may not display physical violence, they absolutely have an affect on those around them (not to mention the effects of second-
hand smoke). A similar argument could be raised about the behavior of other substance abusers such as alcoholics or marijuana smokers that may not directly affect others, but lead to indirect costs.

My stance is that addicts are responsible for their crimes, though they require special punishments. Solitary confinement may not do much for a crack addict, but medication, therapy and consultation might. I will add that a careful use of language is extremely important when discussing these issues. It is not sufficient, or accurate at that, to say all addicts should be punished for their behavior. The negative stigma surrounding addiction is the result of branding all addicts as weak-willed or lawbreakers. Not all addictions are created equal. While both groups of addicts, the ‘dangerous’ addict and the less extreme addict, both effect society, I believe it is important to recognize that they exist in distinct groups.

The distinguishing factor, I believe, is how they affect society. Those who are seen as dangerous or breaking the law, such as physical violence or theft, must be dealt with severely, such that their ailment may be remedied or at the very least, they are no longer in a position where they could repeat the offense. These individuals, whose loss of self-control makes them a danger to others, fall into the same category as the severely mentally disabled. The more mild cases, such as those with nicotine or alcohol dependence, are a little harder to pin down. If they are not breaking a law, the healthcare system, or the judicial system, are not in a position where they can force treatment upon them.

There is a difficult human rights issue that arises went treating mental illnesses, including addiction. Court mandated treatment is common, particularly for serious alcohol and substance abuse. However, it is important to consider the rights, specifically the right to refuse treatment, and the individual integrity of the addict. Dr. Janssens, chair of the Dutch Association for Community Genetics and Public Health Genomics, discusses this in her article, Pressure and coercion in the care for the addicted: ethical perspectives. She brings up the importance of recognizing the competence and autonomy of the addict. In countries such as the Netherlands, Germany and Austria, patients who refuse or fail to give consent cannot be voluntarily admitted for treatment. ‘[They] have to meet the dangerousness criteria of the laws,’ says Janssens and that ‘competent addicts who refuse care should be left alone, unless the threat they pose to themselves or others is sufficiently grave.’ The article also addresses the use of coercion in the treatment of addiction. In this context, coercion is forcing someone to behave in an involuntary manner. Janssens argues that coercion is unethical and that a person’s autonomy is violated as patients are being driven by factors they do not want to be driven by.

Original Image from narconon.na/blog/
I am left with many questions about addiction, perhaps even more than when I began writing this. Addiction, a disease that costs the United States an estimated $600 billion annually, has a large impact on society. There is no magic bullet to cure addiction (yet), which means that it is necessary for us to decide the proper treatment and judiciary action for addicts. It is a strange disease, one that strips patients of their control, without providing protection from the repercussions of their actions. As we continue to study and make decisions regarding addiction, it will be necessary to weigh the importance of an individual’s rights versus the safety of those around them.



Want to cite this post?
Craig, E. (2012). My Brain Made Me Do It. The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2012/07/my-brain-made-me-do-it.html

1 comment:

GmR said...

Nice article. You should check out some of the amazing work NIDA is doing on addiction research. Drug addiction (addiction in general) is a fascinating topic, and I think we'll be seeing the "my brain made me do it" argument more and more as imaging tech and genetics advances.

One thing I want to bring up is your distinction of dangerous and mild addictions. I don't know how much that depends on the people themselves. It seems like it depends on their drug of choice, partly. It seems like the "less dangerous" addicts are so because of the drugs they choose. Nicotine and alcohol are much more accessible, so the element of crime and risk isn't there in getting their fix. On the other hand, you obviously illegal and much more dangerous/costly to obtain drugs of abuse like cocaine and heroin.

So should they punished on their impact on society? Should we let a cocaine addict go if he has the money to pay for his high, while another cocaine addict has to rob or prostitute herself to get a drug?