There is a plethora of explanations given for drug addiction: peer pressure, poor coping mechanisms or simply bad life decisions. Whatever these reasons may be, the common denominator is that addiction is the consequence of voluntary actions. But neuroscience says differently — the truth is that drug addiction is a brain disease as involuntary as having a stroke, and we must change drug criminalization policies to reflect this reality.
The addictive nature of any drug starts with the mesolimbic pathway, more commonly known as the reward pathway. As its name implies, the reward pathway is responsible for reinforcing behaviors that the brain perceives as rewarding. It achieves this by releasing the neurotransmitter dopamine, the “feel good” chemical that creates a sense of pleasure and satisfaction. Normally, we have to work for these dopamine releases, but drugs provide a shortcut. These are the short-term effects that make drugs feel enjoyable, and they help explain why it is difficult to stop after one use.
Repeated drug use fundamentally alters the brain’s structure and chemistry. Excessive dopamine in the brain on drugs results in an amount too overwhelming for our dopamine receptors to handle. In response, the brain begins producing less dopamine, meaning the individual becomes dependent on drugs to supply the neurotransmitter. Conditioning is also at play — just as a dog learns to salivate automatically at the sound of a bell paired with meat, people learn to crave drugs when they are in an environment they associate with drugs.
At this point, drug use is entirely beyond a person’s control. Resisting this urge is not a question of willpower, as doing so results in symptoms like physical pain, hallucinations, depression, and in extreme cases, seizures. These changes persist even after someone stops taking drugs, leaving them craving more.
Given all of this evidence, it seems obvious that drug addiction should be treated as a disease, not a crime. However, many of those addicted to drugs are incarcerated rather than taken to a hospital, as people would be for other brain diseases.
Treating drug addiction requires trained professionals and a series of highly involved intervention methods like behavioral therapy, group treatment and medication.
Punishment by incarceration without treatment is not an effective means of rehabilitation because it does not treat the neurological roots of the disease, namely dopamine deficiency and unlearning the conditioned dependency on drugs. The social consequences of incarceration, like weakened support groups and joblessness, are factors that put people at a greater risk for substance abuse.
While there are drug treatment programs in prisons, studies have shown that they are insufficient.
Following the declaration of the War on Drugs, a series of policies has resulted in a tenfold increase in drug-related incarcerations over the course of 1980 to 2010, according to the National Academies In Focus. According to statistics from the Bureau of Prisons, there are over 74,000 people in prison for drug offenses, by far the highest number of all offenses. However, a study by The National Center on Addiction and Substance Abuse at Columbia University found that there are only enough in-prison rehabilitation programs to properly treat 11% of addicts.
Consequently, post-prison relapse can be deadly — former inmates are at a significantly higher risk of death by overdose in the two weeks following release. As mentioned, a major contributing factor in substance abuse is environmental stimuli that have conditioned a dependency on drugs. If addicts are being released into the environment where they became addicted in the first place, their brains’ instinctual response will be to get back on drugs. Unsurprisingly, it is not uncommon for addicts to get re-arrested within 12 months of being released, according to the National Institutes of Health. This is a vicious, ineffective cycle, and we must break it with science-driven policies that recognize this issue as a disease.
Unless prisons suddenly develop a state-of-the-art rehabilitation system that can accommodate the medical needs of millions of drug addicts, it is clear that jail is not the best place for them to go if we truly want to combat this issue.
For decades, scientific evidence that drug addiction is a disease has been mounting, and it is time for our policies to catch up.
Jessica He is a senior writing about neuroscience. Her column, “Gray Matter,” runs every other Wednesday