Addiction

I remember the event clearly.  All of the 5th and 6th graders in my school filed into the auditorium.  The mood was somber and quiet.  The look on everybody's face was perfectly serious, not a smile or even a smirk could be found.  There was a display on the stage which showed what various illegal drugs (marijuana, amphetamines, narcotics, etc.) looked like.  A policeman began the lecture.  He went through each of the drugs with stern face and furrowed brow, describing the terrible things that would happen to you if you were foolish enough to take them.  He ended with heroin.  He explained that taking it even a single time was guaranteed to leave you permanently and hopelessly addicted and that the craving would cause you to take ever larger amounts until you died from overdose or other factors.

While that lecture was a bit extreme, that pretty much was and still is the narrative of drugs: drugs are extremely addictive and damaging, should be avoided at all costs, and justify the huge costs of the so-called "War on Drugs" which is, of course, really a war on people.

I'm going to explain why I'm extremely skeptical of this narrative.  Let's start with heroin, the bogeyman of drugs.  Heroin is not quite as debilitating as you might think.  It has adverse effects, for sure, but "like most opioids, unadulterated heroin does not cause many long-term complications other than dependence and constipation."  The constipation can be overcome by increasing consumption of leafy greens and other fruits and vegetables.  Addiction (dependence) is an actual problem because it's illegal and expensive, but a perceived problem primarily because it makes us uncomfortable to think that someone might be addicted to something.  If heroin were legal and reasonably inexpensive, then a user who took heroin nightly in moderate doses, even if addicted, would be little different than a drinker who has a couple of glasses of wine nightly, addicted or not.

It's impossible to really know what addiction rates are, especially for a drug that's illegal since that makes studying it somewhat difficult.  However, there are some statistics available.  For example, from the Substance Abuse and Mental Health Services Administration (whose charter is to reduce substance abuse), as of 2010 (latest available year) an estimated 4.1 million people in the United States have used heroin sometime in their life, yet only 618,000 used heroin in the last year and only 240,000 used heroin in the last month.  Even if every last one of the 240,000 users last month is addicted, that's only a 5.8% addiction rate when compared to lifetime use.  Compare this to marijuana (a drug considered to be much less addictive) where over 16% of those who have ever used it also used it in the last month.  While these numbers don't tell us anything terribly concrete, it's hard to reconcile them with the narrative of immediate and permanent addiction.

As Nobel Prize winning economist Gary Becker points out:

The likelihood of becoming and remaining addicted to drugs or other goods is not determined only by personal biological and psychological propensities to become addicted. For example, many individuals end their addictions to smoking and drinking alcohol when they get married, find good jobs, or mature.

This is also difficult to reconcile with immediate and permanent addiction.

At least some experts believe that "Alcohol More Harmful Than Crack or Heroin", with an overall harm index of 72 for alcohol, 55 for heroin, 20 for marijuana, and at the bottom end, a mere 5 for mushrooms.

The lead researcher for this study was David Nutt.  Unfortunately for Dr. Nutt, who was the chairman of the British Advisory Council on the Misuse of Drugs (ACMD) at the time of publication, the need for the evil drug narrative is so strong that he was summarily sacked for presenting this information.  His dismissal lead to several resignations from other researchers in protest.  As a society, we're clearly not ready to face the facts and strive to cling to The Narrative.

I've seen addiction up close because my father was a severe alcoholic who turned his back on his job, friends, and family and lived for years as a homeless drunk. He wasn't alone:  "In the United States and Western Europe, 10 to 20 percent of men and 5 to 10 percent of women at some point in their lives will meet criteria for alcoholism."  Note those are percentages of ALL adults, not just those who drink.

While the addiction rates for narcotics are probably somewhat higher than those for alcohol users, alcohol is a good representative for addictive drugs, especially since we all have experience with ingesting it and observing others who drink.  The spectrum for all drugs ranges from using the drug with no significant negative effects to having a devastating impact on quality and quantity of life with a distribution of these effects being similar to that for alcohol.  Alcohol is bad enough, but the others are no worse (per Nutt's research).  If fact, alcohol is the only drug (other than things like blood pressure medication) for which, when severely addicted, withdrawal can kill you.

To summarize so far, there is no drug that is immediately and universally addictive.  With the possible exception of alcohol, all non-medicinal dependencies can be beat, and indeed, most people do manage and eventually escape addictions to illegal drugs.

On the other hand, the majority of people are addicted to something.  Even ignoring food addiction (when it causes obesity, sometimes severe and even life-threatening), there are all kinds of medicines that keep users alive (for blood pressure, asthma, angina, etc.), there's caffeine (coffee, tea, and don't forget chocolate), there's alcohol and tobacco; and all sorts of other obsessions (video games, porn, sports, etc.) to which people are addicted.  Many of these addictions are beneficial or even life-sustaining.  Others may be detrimental, but it's not the addiction, it's the activity itself that's detrimental.

Even for potentially detrimental things, it's very hard to measure.  For example, smoking an occasional cigar statistically reduces life expectancy which is generally considered detrimental, but if it brings enough pleasure and enjoyment to the smoker, is it really detrimental overall?

The bottom line is that fear of addictive substances is terribly overwrought and has lead to bad policies that have damaged tens of millions of lives and prevented the use of substances that may enhance quality of life overall.