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.
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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.
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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.
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.
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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.
