“DEBUNKING THE MYTH” SERIES

TOPIC 1 – SMOKE AND MIRRORS OF DRUG ADDICTION

 Author: FRANCESCA KEEFE | 14 APR 2021

THE ILLICIT DRUG USER IS MORE THAN A LOW LIFE: DEBUNKING THE MYTH

Is the public perception of illicit drug users wrong? The media often promotes the stereotype of illicit drug users as violent thugs, always on the hunt for their next “high”.  In reality 3.2 million adults, across England and Wales (that is nearly 10% of adults), reported illicit drug use in 2019 alone (Office of National Statistics, 2020). Crucially, these individuals were largely law-abiding, successful and respectable citizens (Harrison, 1994). So why does the social stigmatisation continue? Here, I challenge an assortment of neuromyths in drug addiction, which have, arguably, tainted public perception and have had severe repercussions on clinical research and innovation (Nutt et al. 2013; Ross, 2020). 

NOT ALL PSYCHEDELIC DRUGS ARE ADDICTIVE: DEBUNKING THE MYTH

Drugs that act artificially to alter mood, perception and behaviour are classed as psychedelic drugs (Nutt et al. 2013). Depending on the psychedelic, the effect can be energising, calming and/or hallucinogenic. This is due to the different substances having different modes of action – targeting different brain pathways and different neurotransmitter signals (Nutt et al. 2015; De Gregorio et al. 2021). Of significance is the ability of some (but not all) psychedelic drugs to activate the reward pathway, an innate learning mechanism that positively reinforces specific behaviours (in this case, drug use). Unfortunately, this mode of action has the potential to drive drug misuse and drug dependency (aka drug addiction) in vulnerable individuals. 

DRUG ADDICTION – DEFINED

Drug addiction is a state where an individual craves the drug to the extent of sacrificing other rewards, along with making irrational (often detrimental) tradeoffs to obtain the substance (Wakefield, 2020; Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, 2013). Consequently, leading to the neglect of work, hobbies and relationships. When an addict attempts to become drug-free (abstinence) they inevitably suffer withdrawal symptoms. These can be physical (i.e. headaches, vomiting, shakes), or psychological (intrusive thoughts).  The common outcome being to relapse back into drug taking. People struggling with drug addiction are prone to repeated relapses, even after long periods of abstinence (Pang et al. 2019). 

DRUG ADDICTION – INSIDE THE BRAIN  

The neural mechanisms underpinning this clinical profile have been described in a number of theories, the reward pathway being central to them all (Wakefield 2020). Addictive drugs manipulate neurotransmitter signals, be it GABA, serotonin, glutamate, or dopamine, to the same end: activation of the reward pathway (Nutt et al. 2015; De Gregorio et al. 2021). Significantly, addictive drugs overload the system in a uniquely detrimental way, not observed for non-addictive rewards. According to the “hijacking theory” of drug addiction, this unnaturally high activation of the reward pathway triggers maladaptive learning, which ultimately marks the point of drug dependency: when an individual’s ability to control drug consumption deteriorates.

DRUG ADDICTION IS CURABLE: DEBUNKING THE MYTH

By breaking free of the
narrow view that all
illicit drugs are bad, our
research community has demonstrated their
potential for good.

The hijacking theory of drug addiction provides a more favourable output for a drug addict’s recovery. Instead of being an incurable chronic disease, the hijacking theory suggests that addictive behaviour has the potential to be unlearnt. This outlook has led to rehabilitation strategies focused on retraining the reward pathway to associate rewards with being drug-free. The practice of these so-called contingency management schemes has transformed the treatment of addiction (Petry 2011, Ross 2020). Their efficacy far surpassing that achieved with a pharmacological intervention (i.e. substance substitute) (Petry 2011, Ross 2020). 

The hijacking theory of drug addiction provides a more favourable output for a drug addict’s recovery. Instead of being an incurable chronic disease, the hijacking theory suggests that addictive behaviour has the potential to be unlearnt. This outlook has led to rehabilitation strategies focused on retraining the reward pathway to associate rewards with being drug-free. The practice of these so-called contingency management schemes has transformed the treatment of addiction (Petry 2011, Ross 2020). Their efficacy far surpassing that achieved with a pharmacological intervention (i.e. substance substitute) (Petry 2011, Ross 2020). 

ILLICIT DOES NOT MEAN ADDICTIVE: DEBUNKING THE MYTH

The illegal branding of specific psychedelics has been justified by the reported harm associated with the use of each drug. At the centre of this is the claim that illicit drugs are more addictive than their legal counterparts (such as tobacco and alcohol). However, this remains a matter of debate (Nutt et al. 2007; Hart, 2020). The ranking of a drug’s addictive potential is a combination of if/how strongly a drug activates the reward pathway, along with practical considerations of how easy the substance is to obtain/what does the substance cost. Unsurprisingly, at the top of the ranking are the illicit drugs: opioids (heroin, morphine, opium) and cocaine (Nutt et al. 2007). However, closely following are tobacco and alcohol (Nutt et al. 2007). Although both substances have high addictive potentials, tobacco and alcohol retain their legal status. Whereas, LSD and psilocybin (aka magic mushrooms) have no physical addictive properties, but are illegal.   

DRUG USE IS UNLIKELY TO END IN DRUG ADDICTION: DEBUNKING THE MYTH

How addictive is a “highly addictive” drug? Despite the propaganda, the path of illicit drug use to addiction is not a simple one. 70-90% of illicit drug users never develop drug dependency (Grifell & Hart, 2018). Expectedly, the type of drug and the frequency of use significantly impacts an individual’s risk. The higher proportion of users that transition to addicts typically being those using higher ranked addictive drugs (i.e heroin and cocaine). Nonetheless, this fact awakens us to the truth: illicit drug use is not sufficient to cause addiction (Ross, 2020). Logically, it follows that additional factors mark an individual’s risk of drug addiction (Ersche et al. 2020).  Seemly unrelated factors have been robustly implicated in marking an individual as vulnerable, including: genetics, gender, social (i.e. life adversities) and economic status (Redonnet et al. 2012; Ersche et al. 2020; Oliverio et al. 2020; Munn‐Chernoff et al. 2021). 

REPERCUSSIONS OF THE MYTHS

Despite the above, the ban on illicit drugs remains.  The repercussions of which impacts the society, economy and health sectors (Nutt et al. 2013).  In regards to society, illicit drug users and addicts are often treated as outcasts. The negative impact of which can fuel continued drug use, and hinder the rehabilitation and acceptance of recovering addicts back into society. Moreover, our economy is drained by law enforcement costs against the illicit drug trade that amounts to an estimated £780 million annually (Fell et al. 2019). Despite this staggering figure, law enforcement impact is marginal at best. In terms of health, the transition of banned psychedelics into the clinic has been an uphill battle, despite evidence of their efficacy and safety (Krediet et al. 2020). Fortunately, the last decade has seen a boom in the clinical application of illicit drugs (including LSD, ecstasy and ketamine) in the treatment of neuropsychiatric disorders (Nutt et al. 2013; De Gregorio et al. 2021). By breaking free of the narrow view that all illicit drugs are bad, our research community has demonstrated their potential for good.

Edited by: Steliana Yanakieva and Peter Richardson

REFERENCES

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