Drugs and Alcohol

Not a New Problem - We Need New Solutions and New Societal Attitudes

The Problem

Overdose deaths, addiction, homelessness and endless suffering from drugs and alcohol is a ongoing problem with a tremendous cost in both human lives and dollars. Our society cannot continue to accept this as the new norm. Resolving these issues will require a massive coordinated effort of medical and social scientists along with public policy changes to attack the sources of the problem to prevent new addiction and suffering. The previous war on drugs failed. But new technological advances such as powerful synthetic opioids, e-cigarettes (nicotine, THC and more), and candy based edible drugs are resulting in greater challenges in keeping children safe. The "surrender" experiment by several states to legalize possession of all illicit drugs has failed miserably. The cost to our healthcare system is enormous, but that is not the worst part of the problem. We still don't have a "system of treatment" that is truly effective in curing addiction. This is because:

1. Although the science behind addiction is becoming better understood, treatment approaches today are not based on that understanding. The vast majority of treatment involves short term outpatient (individual and group counseling) and inpatient treatment (i.e. 30 days in small residential homes based on AA and CBT relapse prevention) followed by living in unregulated "sober" living homes. Medication treatment methods are, for the most part, replacement therapies.

2. While insurance is required to pay for treatment, successful treatment is not a requirement for getting paid. In fact 90+% of patients will relapse within 12 months. Many will overdose.

3. Because this disorder affects impulse control, decision making and results in powerful cue-induced cravings, individuals often refuse treatment or will leave treatment early. Laws and public policy do not recognize that individuals struggling with this disorder are very likely incapable of making informed choices regarding their treatment, regardless of age.

4. Public policies have resulted in greater access to illicit drugs which makes it easier to access drugs after treatment has ended.

Marijuana

The "medical marijuana" movement and legalizing adult recreational marijuana use in 24 states has resulted in the increased availability of THC based drugs to minors, In California, for example, Proposition 64, the "Adult Use of Marijuana Act" lobbied by special interests and passed by voters in 2016, made minor possession of marijuana in all forms, concentrations and quantity, even in a school setting, no longer a crime. It is now an infraction subject to a maximum penalty of a taxpayer funded free drug class and community service. It is clear why the laws regarding minors were targeted as minors represent a significant portion of marijuana consumers. What is less clear is why voters approved it with those specific changes and why the Governor and other legislators did not sound the alarm. It is likely neither the voters nor government leaders, based on the size and the way the initiative was drafted, were aware of those provisions of the initiative.

Ironically, the legalization of marijuana for adults has only increased an illicit drug trade for both adults and minors. Also it is likely legalization has resulted in an increase in use by minors (Paschall, et al., 2021). Of course the availability of discrete and convenient delivery system of vape pens has certainly made use more convenient and, with higher potency, increases the risk of addiction. Unfortunately, more and more research is emerging about the harms, some permanent, of cannabis use by children. We need to signal the alarm. Dangers of cannabis for children abound, from small children eating edibles, ER visits for overdose, induction of psychosis and permanent IQ loss are just a few.

Battle to Find an Effective Cure for Addiction

The National Institute on Drug Abuse states that addiction an incurable chronic condition that must be "managed", This suggests surrender. Helping to End Addiction Long-term Initiative, or the NIH HEAL Initiative was established in 2018 as a result of the opioid epidemic to find "scientific solutions". The goals of this initiative are to learn more about pain and pain management and to find effective treatment methods for opioid addiction. A look at the grant funding opportunities for treatment are almost exclusively medication trials. This is not surprising, however what if medications, while perhaps useful in symptom reduction could never be the cure?

The research regarding the science of addiction and dependency suggests the "cause" of addiction is, among other things, neural connections (wiring) resulting in a "hijacked" reward center (ventral tegmental area, nucleus accumbens and prefrontal cortex). If this is true as many believe, the implication is that the cure would require new neural connections that mediate the old wiring and/or mechanisms to disrupt the existing specific wiring in the reward center that resulted in addiction. Three ongoing studies testing the use of Focused Ultrasound in treating cocaine use disorder, food addiction and chronic pain and alcohol use disorder (https://www.fusfoundation.org/diseases-and-conditions/addiction-other/) seem to be targeting the disruption theory. Another area of promising medical research has been the study of the use of psychedelics in the treatment of addiction (Zafar, et al., 2023). Positive treatment effects have been identified in small scale human studies. What remains a mystery, despite neuroimaging research, is what is causing these positive effects. What is significant about the use of these substances is that patients report profound experience and changes to their outlook on life. Is this the new neural connections to mediate the wiring of the addiction? Does this disrupt the wiring of the addiction or is this another purely biological mechanism? Results have not shown complete cures however the treatment effects seem to be significant. What is needed is more clinical research, based on the latest scientific findings. What is also needed are efforts to prevent addiction in the first place.

A New War on Drugs

Instead of surrendering, a new war must be initiated with no outcome acceptable other than victory.

Our society must reconsider the failing trend to decriminalize all drug possession or reduce the penalties so that treatment can be an option instead of incarceration. Thankfully in California, Proposition 36, passed by a huge majority (70%) reversing some of the infamous Proposition 47 mistakes. We must consider how to prevent and treat illicit drug use in the first place using every tool available to parents, educators, clinicians, law enforcement and the justice system. With Fentanyl related poisonings and overdose deaths still an epidemic, can we afford not to do this?

1 Paschall M., García-Ramírez G., Grube, J. (2021) Recreational Marijuana Legalization and Use Among California Adolescents: Findings From a Statewide Survey.

Journal of Studies on Alcohol and Drugs 2021 82:1 , 103-111

2 Zafar, R., Siegel, M., Harding, R., Barba, T., Agnorelli, C., Suseelan, S., Roseman, L., Wall, M., Nutt, D. J., & Erritzoe, D. (2023). Psychedelic therapy in the treatment of addiction: the past, present and future. Frontiers in psychiatry, 14, 1183740. https://doi.org/10.3389/fpsyt.2023.1183740

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