Business World, 19 December 2016


Sometime in the distant future, when Filipinos regain their sanity, they will likely remember some enduring memes in the government’s current war on drugs. Those memes must certainly include President Duterte’s answer on August 26 to a reporter’s question on the mounting death toll of drug-users and the threat of his being charged with crimes against humanity. The president responded: “Crime against humanity? In the first place, I’d like to be frank with you. Are they humans? What is your definition of a human being?” (Emphasis supplied.)

But this itself merely elaborates on an earlier statement by the president in Cebu on June 25 when he said: “The problem is once you’re addicted to shabu, rehabilitation is no longer a viable option. …If I couldn’t convince you to stop, I’ll have you killed… if you’re into drugs, I’m very sorry. I’ll have to apologize to your family because you’ll surely get killed.” (Emphasis supplied.)

This view of drug users as being beyond all help and hope was a common one— in the 1970s. The scientific work underlying it, fittingly enough, was based on nonhumans. Researchers devised ingenious lab experiments that allowed rats and monkeys in cages to administer drugs (usually morphine) to themselves. The scientists observed that the animals pressed on levers with increasing frequency to inject themselves with drugs until they became fully addicted. A typical study of the time concluded that “becoming addicted requires nothing more than availability of the drug, opportunity for its use, and (in man) willingness to use it” (Goldstein [1972], also quoted in Alexander [1985]).

The message conveyed is that psychoactive drugs are just so potent, ingesting even small amounts leads to an irreversible slide into addiction and its inevitable consequences—compulsive behaviour to feed the habit, permanent brain damage, dysfunctional social relations, inability to fulfil work obligations, psychosis, and even death. The classic anti-drug ad in the U.S. was that of a rat compulsively licking at a bottle with cocaine-laced water, running around uncontrollably in its cage until it fell dead from exhaustion. From this it was but a small step to the belief that anyone who even tried drugs was inevitably going to be addicted; and that his life from then on was likely to be meaningless shit. (Ergo, what’s the big loss in snuffing it out?)

Since then, however, the understanding of addiction has changed. The fact is, the great majority of people who have tried using psychoactive substances do not become addicted.

In the U.S., only a fifth of people who had ever tried drugs in their lifetime still used it within the past month. Philippine figures (for 2008) are not too different: in the 10-69 year-old age bracket, some seven million people said they had tried drugs in their lifetime. Yet only 1.7 million of them were still using drugs in the past month.

Why and how do so many manage to avoid chronic use and addiction? Frankly the jury is still out. A forum in the New York Times a few years ago (10 February 2014) hints at where things stand: Is addiction a disease? Or caused by a lack of will power? Is it a learned habit that can be unlearned? Or a behaviour induced by larger socio-economic circumstances like poverty, race, etc.?

One might simplify, however, and reduce the matter crudely to genetics or environment—or both. Certainly genetic-metabolic theories force us to modify the caricature of an inevitable downward descent into perdition. Just as some people get drunk less easily, others may just have a more robust dopamine reward system that is less vulnerable to the pharmacological effects of drugs. Studies of twins suggest that as much as 50-60% of the risk of alcoholism and drug addiction may be inherited [Prescott et al. 2016]. Good genes may be the reason that people like Manny Pacquiao—who has confessed to using shabu and cocaine “for years”—still manage to kick the habit without any rehab and to succeed magnificently in their careers. Similarly, many recreational drug users (especially of marijuana, but also of tobacco and alcohol) are actually “high-functioning addicts” who occupy responsible positions and discharge their work reliably. The point is there is no one-size-fits-all. Not all experimenters become users; not all users become addicts; and not all addicts are dysfunctional.

As for environment and learning, it turns out even those old rat experiments themselves were defective in a fundamental respect. For they placed the animals in a deprived environment, kept each isolated in a cage, and left them no alternative activity except to press the lever to administer morphine to themselves. Bruce Alexander and his colleagues (1978, 1981) created an alternative environment for rat-subjects (calling this “Rat Park”) with opportunities for varied play, real food, and sex. Most importantly, in this second environment, the rats were given two liquid options: the morphine-laced solution or plain tap water. The result was that rats reared in Rat Park consumed far less of the morphine than those reared in isolated cages. Even rats originally raised in the morphine-only cages came to prefer tap water once they were moved to the richer environment. This experiment strongly suggests a more varied, more activity-filled environment may reduce the attractiveness of psycho-active drugs. Indeed, one might argue that the addiction itself may have been prompted by deprivation and a problematic environment.

As it happens, a similar phenomenon is observable in humans. Carl Hart, the department chair of psychology at Columbia University (and former drug user), became widely known for his research observing the choices of real-life crack and shabu addicts. His research team [Kirkpatrick et al. 2012] offered addicts varying amounts of cash—payable only at the end of the experiment several weeks later—in exchange for their refraining from smoking crack or meth on a given day. As the cash reward rose ($5, 10, 15), more and more addicts chose the prospective cash over the immediate pleasure of shooting drugs for the day. At a $20 payoff, all the addicts chose to forego taking drugs on the given day. Hart had essentially mapped an upward-sloping supply curve of effort and shown that addicts were not the mindless zombies with uncontrolled urges that they were portrayed to be. Rather they were fully capable of making rational economic decisions—particularly that consummate human trait of sacrifice and delayed gratification. Like Alexander’s Rat Park, Hart’s experiments showed that addictive behaviour can be modified by a provision of options and alternatives: “Treatments based on providing alternatives to drugs have shown repeatedly that they can be effective in changing addictive behavior…The idea comes from basic behaviorism: our actions are governed to a large extent by what we are rewarded for in our environment” [Hart 2014].

This work and others like it suggest that drug use and addiction may be largely prompted by a lack of options in the social environment, which may also turn genetic switches on and off. Like rats in isolated cages, people burdened by poverty, anomie, and lack of prospects may merely be responding to their circumstances by taking to drugs. And they may just as likely abandon such behaviour—as people like Hart and Pacquiao were able to do—when prospects change for the better, or when they are presented with superior options. It is a functioning society that is able to provide such options to its citizens; it is a failed state, on the other hand, that takes lives away before a chance at recovery can occur.

The true scandal of the current drug war is that it is run by old men who operate on old ideas and obsolete knowledge. It therefore subjects citizens to what is ultimately an unnecessary—and therefore unjust—ordeal. Our predicament is not far from the episode of bizarre lobotomies performed on thousands of patients in Europe and the U.S. during the 1950s. Ordered by authorities who thought they were treating “mental disorder”, these procedures led not only to unneeded deaths during the operations themselves, but also to suicides, and the permanent mental maiming and “surgically induced childhoods” of thousands of citizens. With the introduction of anti-psychotic drugs, this practice was almost universally abandoned and regarded as cruel and unusual, though not before thousands of lives had been ruined or lost.

When we do finally recover from our collective mania—and we will—we might well wonder, given what we now know, whether it was addicts who were not human, or rather we who were inhumane.