If it wasn’t rational, cont’d

English: Cocaine user "tweaking" or ...
English: Cocaine user “tweaking” or withdrawing from cocaine searches ground for small bits of lost or overlooked crack cocaine, while standing beneath an anti-cocaine graffitum. (Photo credit: Wikipedia)

Yesterday I posted about a recent NY Times column arguing for a rational model of addictive drug use:

“When they were given an alternative to crack, they made rational economic decisions.”

When methamphetamine replaced crack as the great drug scourge in the United States, Dr. Hart brought meth addicts into his laboratory for similar experiments — and the results showed similarly rational decisions.

“If you’re living in a poor neighborhood deprived of options, there’s a certain rationality to keep taking a drug that will give you some temporary pleasure,”

I was thinking about it a little more and several people have spoken with me about it.

I have two thoughts that I’d add to yesterday’s post.

First, it might be rational if the person’s life is hopeless. This premise worth thinking deeply about.

nihilism by Brett Jordan
nihilism by Brett Jordan

Second, several people have commented on the ethics of his studies:

Dr. Hart recruited addicts by advertising in The Village Voice, offering them a chance to make $950 while smoking crack made from pharmaceutical-grade cocaine.

Um, yeah.  There is that. It never ceases to amaze me that a human subjects review board would approve this kind of study.

7 thoughts on “If it wasn’t rational, cont’d

  1. Hey Jason, However the implications of this study, both clinically and politically, are in many ways promising. But I’m not sure about the rational choice model.

    I think most human behaviour, including healthy, is instinctively in response to our social and physical environment. Rational thinking is hard work, it’s needs conscious pre-frontal lobe effort which the addicted reptilian part of our brain can so easily overwhelm. In any case the evolutionary function of our monkey mind reasoning it to get what the lizard brain wants. Most of us, myself included, are so crap at reasoning – subject to powerful emotional and logical biases. It is the highest order parts of our brain/mind that needs to be engaged – that part whose job it is to find meaning, purpose and value in life. That part of the brain is not rational – it is beyond reason.

    There is an idolatry of reason in Western culture going back centuries – an Enlightenment hangover – in modern form appears as homo economicus – the rational self-interested actor – who consistently evaluate the cost and benefits of actions and lifestyle choices – a principal theme of neoliberal capitalist economic and political theory.

    The profound risk of the rational choice theory is that it implies addicts consciously choose the consequences of their behaviour and therefore are entirely and individual responsible for their resolution. “You chose this life, you fix it.” It also means that there is no point funding treatment because addicts as rational actors can stop any time they want.

    At the heart of the moral model of drug use is the concept of rational choice which comes out as “You choose to do ‘bad’ things which makes you a ‘bad’ person. We can help you make the right choice, (which we know you can do because you are a rational actor consistently evaluating cost/benefits of actions and lifestyle choices) by raising the stakes of using. If we make using bad enough by promoting disease, violence and chaos in your world, then eventually you will come to your senses and make the right=good=rational decision to stop using. If not at least others will see the world of hurt you are in and make a rational choice to not do what you have freely brought upon yourself.

    I think what the researchers are trying it say by using the the idea of rational choice is that it makes sense to use drugs when you live in such shitty, stressful, hopeless social environments i.e. it appears to be a rational choice to medicate yourself.

    Therefore instead of focussing and blaming the individual look at where they live and what can be done about that.

    I have a lot of sympathy for this social justice perspective on addiction – I do see addiction as much a social and environmental phenomenon as an individualised brain disorder which itself can be seen as just a neural map of the addict’s dismal outside world. The good news being, if you can do something about the outside world (even if its just the little part they have influence over i.e. who you hang out with) then the inside brain wiring tends to fix itself – albeit slowly and perhaps never without lasting damage.

    The researchers thinking looks like a rejection of the “disease model” in favour of a social model of addiction but personally I think that is a step forward.

    The biomedical disease model tends to privilege the pharmacological effects of the drug on the individuals brain over the behavioural, psychological, social, and environmental aspects of addiction. The addiction is located irrevocably in the individual “diseased” brain. If you buy too deeply into the biological disease model then you see only biomedical solutions and as Bill White pointed out a relentless focus on “disease” can be powerfully stigmatising.

    One of the great ironies of the this field that those who reject the “disease” model often promote biomedical techno fixes as the only viable solution, whereas proponents of the “disease” model tends to promote addressing in a holistic manner the behavioural, psychological, social, and environmental aspects of addiction, but often look askance at psychotropic medications that can soothed a fevered brain.

    The traditional 12-step disease model was originally meant to be a functional metaphor – an antidote to blame and stigma of the the prevailing moral model – an appeal to see addiction as a social and health issue – “We are not bad people trying to be better -we are sick people trying to get well.”

    It certainly can be really helpful for people to think of their condition as like a lifestyle disease such as diabetes or heart failure requiring long behavioural changes and commitment to self-care such as dietary changes and exercise.

    In the case of a 12-step approach to addiction the long behavioural changes being how and who you spend time with and commitment to self-care such as abstinence and the emotional and spiritual exercise of fellowship. But in and out of the rooms it has become hopelessly conflated with the prevailing brain disease model – and it’s all become very confusing.

    As the researcher says

    “The key factor is the environment, whether you’re talking about humans or rats,” Dr. Hart said. “The rats that keep pressing the lever for cocaine are the ones who are stressed out because they’ve been raised in solitary conditions and have no other options. But when you enrich their environment, and give them access to sweets and let them play with other rats, they stop pressing the lever.”

    He is referring to the delightful 1970’s Rat Park experiments of Bruce Alexander – who after a long hiatus has recently returned to the addictions field with his book the Globalisation of Addiction which presents what I can see is one of the most powerful models of addiction yet – the Dislocation Theory of Addiction – which he argues is a rational/instinctive/understandable response to dislocation – which can be social, cultural, environmental or spiritual. I think this theory deserves to be the foundational theory of recovery by more than the confusing disease model or the scary rational/moral model.

    The incredible power of programs like Dawn Farm and 12-step is that they help address this dislocation – helping people relocate within the world and within themselves.

    1. You’ve provided A LOT to chew on. I appreciate your thorough and considered response. I also have a lot of sympathy for the social justice perspective, and I agree that social and environmental factors often get lost in disease discussions. I agree that those factors are important, but I don’t accept them as causal and I don’t believe that improving social and environmental factors would be curative. They are necessary, but not sufficient. For example, in the US, there is a strong push for a “housing first” model to addressing homelessness. The assumption is that we can’t reasonably to expect people to address factors like employment, mental health and addictions before they are securely housed. This often means that there are no contingencies and expectations of recovery. Our experience is that this approach fails addicts with low expectations. The result is housed active addicts who then engender resentment and stigma as a waste of resources.

      I hope that discussion of those considerations is a step forward, but I don’t have your faith in that. I think that framing it as a choice doesn’t necessarily lead to a focus on these factors, but starts a search for other factors and I think character-based explanations are likely to prevail.

      Thanks for the kind words. Your comments are always impressive and thought provoking. You need to start a blog!

      1. Lol, thanks Jason in fact your writings have inspired me to do so. I’ve been working on it the last week and I’m nearly finished the design – stay tuned.

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