Dramatic advances over the past two decades in both the neurosciences and the behavioral sciences have revolutionized our understanding of drug abuse. Scientists have identified neural circuits that subsume the actions of every known drug of abuse, and they have specified common pathways that are affected by almost all such substances. Researchers have also identified and cloned the major receptors for virtually every drug addiction as well as the natural ligands for most of those receptors. In addition, they have elaborated many of the biochemical cascades within the cell that follow receptor activation by drugs. Research has also begun to reveal major differences between the brains of addicted and non-addicted individuals and to indicate some common elements of addiction, regardless of the substance.
That is the good news. The bad news is the dramatic lag between these advances in science and their appreciation by the general public or their application in either practice or public policy settings. There is a wide gap between the scientific facts and public perceptions about drug addiction. For example, many, perhaps most, people see this problem as social problems, to be handled only with social solutions, particularly through the criminal justice system. On the other hand, science has taught that this is as much a health problem as a social problem. The consequence of this gap is a significant delay in gaining control over the drug abuse problem.
Part of the lag and resultant disconnection comes from the normal delay in transferring any scientific knowledge into practice by policy. However, there are other factors unique to the drug abuse arena that compounds the problem. One major barrier is the tremendous stigma attached to being an addict. The most beneficent public view of drug addicts is as victims of their societal situation. However, the more common view is that addicts are weak or bad people, unwilling to lead moral lives and to control their behavior and gratifications. To the contrary, addiction is actually a chronic, relapsing disease, characterized by a compulsive drug seeking and use. The gulf in implications between the “bad person” view and the “chronic illness sufferer” view is tremendous. As just one example, there are many people who believe that addicted individuals do not even deserve drug treatment. This stigma, and the underlying moralistic tone, is a significant overlay on all decisions that relate to users.
Another barrier is that some of the people who work in the fields of addiction treatment and prevention also hold ingrained ideologies that, although usually different in origin and form from the ideologies of the general public, can be just as problematic. For example, many drug abuse workers are themselves former users who have had successful treatment experiences with a particular treatment method. They therefore may zealously defend a single approach, even in the face of contradictory scientific evidence. In fact, there are many treatments that have been shown to be effective through clinical trials.
These difficulties notwithstanding, we can and must bridge this informational disconnection if we are going to make any real progress in controlling drug addiction. It is time to replace ideology with science.