Brain images tell nothing about addiction

The New York Times, and its science writer Daniel Goleman, blared the headline, "Brain Images of Addiction In Action Show Its Neural Basis" (August 13, 1996). The article reviews research showing that many different drugs -- namely heroin, alcohol, amphetamines or nicotine -- activate common neural pathways. Goleman summarizes that these drugs bathe the neurons at these sites so as to reduce natural supplies of dopamine, and thus stimulate a craving for more of the drugs to compensate for this depleted supply of the neurotransmitter.

Dr. Alan Leshner, director of the National Institute on Drug Abuse, welcomes these findings and such analyses because they "offer an extraordinary insight into the brain basis of drug addiction." The article refers to the famous rats which would do nothing but stimulate these supposed pleasure sites in the brain, ignoring even the need to eat and drink (for refutation of this summary, see "Cocaine and the concept of addiction: Environmental factors in drug compulsions," Stanton Peele's Greatest Hits). According to Goleman, "The same system seems to be ordinarily in play to provide a sense of pleasure in whatever people find rewarding, like sex or chocolate or a job well done."

As we read these new claims that one set of neurological mechanisms accounts for a rather large range of behavior, we might modestly keep in mind neurologist Richard Restak's excitement in 1977 (now close to two decades ago) "about a veritable philosopher's stone -- a group of substances [endorphins] that hold out the promise of alleviating,or even eliminating, such age-old medical bugaboos as pain, drug addiction, and, among other mental illnesses, schizophrenia ("The brain makes its own tranquilizers", Saturday Review, March 5, 1977, p. 7).

Of course, the claim is, this was a false alarm but now we have really discovered the site in the brain that governs addiction. In fact, this research tells us nothing about addiction:

1. These findings do nothing to explain the most striking and commonplace observations about the street use of drugs. Most people who take "addictive" drugs do not become addicted. Most people who become addicted cease addiction, often simply cutting back on the drug. Vietnam soldiers addicted to heroin in one setting (Vietnam) were not able or were unwilling to be addicted when they returned home, even after resuming drug use. Those who fail to achieve remission from addictive drugs differ significantly in social and psychological profiles from those who do -- those with more ample resources achieve remission most readily and stably, even given continued exposure to the addictive substance.
2. Such supposedly scientific discoveries immediately require whole new levels of supposition and hypothesis in order to account for data on actual drug use. The researchers who acknowledge reality and note that most drug users, even regular users, do not become addicted are immediately required to hypothesize inbred biological differences in the neurological mechanisms that predispose some people to addictive drug use -- although their own data show no such differences related to addictive drug use. That people recover from addiction and resume non-addictive use of the same drugs forces hypothesizing about complex neurological-situation interactions on which the researchers likewise have no data. That susceptibility to addiction and failure to achieve stable remission are related to systematic social differences could result in racist theories -- i.e., inner city addicts fail to escape addiction (to heroin, crack, cigarettes, and alcohol) as readily as middle class people because they are biologically predisposed to addiction.
3. Those drugs now lumped in as addictive with heroin -- such as cocaine and amphetamines -- were for decades labelled by leading psychopharmacologists as non-addictive. Isn't it strange that now we discover biological hard wiring to explain cultural variations in labelling, such that leading psychopharmacologists averred unhesitatingly until the 1980s that cocaine and amphetamines, which are now said to stimulate the same pleasure centers as heroin, did not produce the addictive effects that heroin does? (see "Addiction as a cultural concept," Stanton Peele's Greatest Hits).
4. The wide range of activities that stimulate the pleasure centers of the brain -- including sex, eating, working, chocolate -- should alert us that these brain theories tell us nothing about differences in behavior, let alone addiction. Most people experience orgasm as among the most pleasurable sensations -- yet how many people become addicted to orgasms? Chocolate stimulates the pleasure centers, but only a few people compulsively eat chocolates or sweets. Apparently, stimulation of a pleasure center is only one small component in the entire addiction syndrome. Moreover, if any activity can be pleasurable -- from work, to sex, to parenting and so on -- identifying activities as stimulating the pleasure center simply begs the questions: Why do people find different things pleasurable and Why do different people react in destructive, addictive ways to some of these things, while others incorporate them into a balanced overall lifestyle?

This is, after all, the mystery and the problem of addiction.