America's Brain on Drugs
Brain science shows why the War on Drugs is failing
By Shawn Lawrence Otto | Jun 27, 2011 | Comments (0)
This month, forty years after Richard Nixon first declared America's War on Drugs in 1971, the UN's Global Commission on Drug Policy released a searing indictment of the program, declaring it a failure. Two bizarre cases from neuroscience hold keys to understanding why, from a scientific perspective, the War on Drugs has not been successful.
In June of 2001, Andrea Yates, a 36-year old Houston, Texas mother and wife of a Shuttle space engineer, drowned her five children in the bathtub. She had in many ways been an upstanding citizen. She was an RN, had been her class valedictorian, captain of the swim team and an officer in the National Honor Society. She called the police after the crime, and her comments suggested she knew it was wrong. She had nevertheless felt a compulsion to do it for some time, she told investigators, even though both she and her husband had wanted to “have as many children as God would allow.”
In 2000, a respected middle-aged Virginia man began to collect child pornography and sexually molest his 8-year-old stepdaughter. He knew it was wrong and tried to hide it, even thought about suicide, but yet he felt compelled. After his arrest, the judge gave him a choice: either undergo inpatient rehabilitation in a 12-step program for sex addicts or go to jail. Despite his strong desire to avoid prison, he solicited sexual favors from staff and other clients at the rehab center and was expelled. The night before his prison sentencing, he went to the hospital complaining of a severe migraine. He was found to have a benign tumour in the orbitofrontal area of his brain, in a region known to regulate sexual and social behavior.
The tumor was removed, and he returned to normal. But then after a few months, his sexual focus on young girls rekindled. A new scan revealed that bits of tissue missed in the surgery had grown into a new tumour. It was removed and once again his behavior returned to normal.
There are countless other examples of what neuroscientists are now calling control disorders - compulsions that drive behavior in which a part of the brain is acting without conscious control. This is also what happens in drug and alcohol addiction, which is what makes it such a confusing area for our criminal justice system to properly address.
It all centers around our ideas about free will and responsibility. Did Andrea Yates or the Virginia man have free will? Were they responsible for their actions? “Yates was not insane in the traditional sense of the law,” bioethicist and attorney Linda Glenn told me. This is because most states still use something called The M’Naghten Rule to set the test for legal insanity. The M’Naghten Rule basically says you are insane if you cannot appreciate the wrongness of your actions. But both Andrea Yates and the Virginia man could – they knew what they were doing was wrong, but they still had an uncontrollable impulse. How could this be? Glenn says there are two conflicting brain centers. “Most people would say Yates was clearly insane but the way the law has defined it she was not.” Which is one of the reasons the prosecutor wanted to go for the death penalty.
A case like Yates’ shows why we need a new definition. Neuroethicists say we need to create a different category of brain disorders that recognizes that consciousness is not a unified whole but arises from many brain systems, and that explains when one of those systems goes wrong and people act out of control. Under this new way of thinking there is not one but many different types of ‘insanity,’ and one of them is the inability to control your behavior. Addictions and obsessive-compulsive disorder are examples of brain centers that have lost the physiological balance to be consciously controllable without some form of outside intervention, which is why they are so “crazy-making” to the afflicted and their loved ones.
“The cost of imprisoning people for drugs and addiction is something like $41 billion for interdiction alone per year,” says neurophilosopher Pat Churchland. Her numbers are right. According to the Office of National Drug Control Policy, the federal government spent over $15 billion in 2010 on the War on Drugs, and state and local governments spent an additional $25 billion according to a 2010 report by the Cato Institute. “And in human cost the cost is tremendous. Clearly something has to change based on our new understanding of the neurobiology of addiction. It’s not a moral failing; it’s a brain disorder.”
As this becomes more clearly understood, the idea of disciplining or jailing someone for an addiction will likely eventually be seen as barbaric and neanderthal as beating an autistic child to get him to "straighten up" or shaking a baby to get her to stop crying. If the conscious part of the brain is not in control, the expectation is simply not an applicable part of the equation.
Glenn agrees, and says the problem applies to a whole host of criminal justice situations. “People are not always competent and cannot always be held to the same standard depending on the situation. Do we need to create new categories? Yes. You would probably not hear a neuroscientist use the term ‘insanity,’ it probably reflects the legalistic approach. You’d hear a neuroscientist talk about a dysfunction of rationality or some brain process.”
In fact, the term insanity is currently collapsing as neuroscience knowledge expands. It is becoming more of a legal contrivance than anything real or measurable.
Instead, neuroscientists testify about control disorders, injuries in various brain systems, neurotransmitters and gene expression. It is a classic example of refined knowledge requiring more precise refinements of morality, ethics and law – and the great upheavals that implies for existing power structures based on “common” sense – in this case, our religious and criminal justice systems.
This is, of course, not new:
- Melancholy and hysteria have been revealed to be varieties of depression and anxiety, associated with neurotransmitter imbalances in differing brain systems.
- Shell shock was an obvious condition to everyone that eventually became Post Traumatic Stress Disorder, a constellation of associated conditions emanating from the various brain systems affected by sustained stress. Treatments are emerging that combine cognitive therapy with drugs that block the ability of the amygdala to charge memories with emotion, breaking the cycle.
- Demonic possession, commonly discussed in the middle ages, was eventually revealed to be Huntington’s chorea, in which there is a decline in regulation of motor and cognitive function.
- Bewitchments leading to the Salem witch trials and other witchcraft charges were more recently shown to have likely been caused by ergot, a fungus that periodically infests grain crops. Ergot contains isoergine (lysergic acid amide), a precursor alkaloid to LSD.
This all becomes enormously important when it intersects with the War on Drugs. Mexico's past two presidents, Ernesto Zedillo and Vicente Fox, once leaders with the US in the effort, last week issued a joint statement saying that legalizing drugs may be the only way to stop the escalating cycle of violence the US policy has unleashed. The US needs to find a better way to deal with its consumption problem, they say. But dealing with a consumption problem that is out of the hands of conscious control by taking a military, interdiction, or criminal justice approach is not a winning strategy. In the end, the biggest drive behind ending the war may be its economic unsustainability.
Since the program was implemented, US incarceration rates per 100,000 people have skyrocketed and are now number one in the world. It costs more then $25,000 annually, on average, to imprison someone in the United States - roughly the same as a college education. More than one in three young black men without a high school diploma is now behind bars, along with one out of every eight whites.
The Pew Charitable Trusts released a report last year showing the devastating effect this is having on our economy in terms of employability and economic mobility. People with a prison record tend to get stuck in low wage jobs and often fall back into the black market because legitimate employers are hesitant to hire them. This leads to rearrest and more jail time - at enormous and mounting cost to taxpayers in a down economy. Ultimately, the cycle this creates accelerates a two-tiered socio-economic structure.
The failure of US drug policy under the War on Drugs to actually stem drug use is a case illustration of the costs of applying a morality-driven approach over that of science in guiding public policy - an approach that is informed by what feels good instead of what is true. Proponents of evidence-based policymaking say we need first to understand what is true, and then decide what feels good based upon knowledge, not the other way around.
To that end, Churchland says, "let's be clear. Just because you have a brain disorder or an addiction doesn't mean you're not responsible for your actions. The job of the criminal justice system is to ensure public safety." And there are some disorders which we don't yet understand enough to be able to treat them successfully enough to justify the risk of releasing an offender back into society.
But applying the one-size-fits-all, disciplinarian approach of the War on Drugs or encouraging people to "just say no" to a problem that is defined by its lack of conscious control is not unlike the drunk looking for his lost car keys under the street lamp because it's brighter there. However well-intentioned, it is guaranteed to fail. To date that failure has had significant costs in terms of loss of wealth, loss of life, loss of potential, and economic ruin. It's time we apply a smarter model.
Tags: Politics, Economics, Neuroscience, Education