Addiction in five charts

A few interesting charts about addiction. They touch on various aspects from drug laws to neuroscience to the US opioid crisis.

Laws, wars, conquistadors

In 2001 Portugal decriminalised the possession and consumption of all drugs, the first country to do so. If you’re caught with a personal supply (less than 10 days worth) you are not arrested. Instead, you typically get a meeting with a doctor, a social worker and a lawyer to discuss harm-reduction, treatment and the support services available.

Drug-related deaths have plummeted, from several hundred annually before decriminalisation to about 40 in 2017. HIV infection dived from an all-time high of 104 new cases per million people in 2000 to 4 in 2015.

Portugal has the lowest rate of drug deaths in Europe, and a rate 54 times lower than the US. Decriminalisation has been touted as the way to “win” the so-called war on drugs.

The Portuguese Health Ministry spends less than $10 per citizen annually on its drug policy.  The US has spent about $10,000 per household (more than $1 trillion) since the 1970s on its drug policies, according to this NY Times piece.

Dopamine is about wanting, not pleasure

Dopamine is mistakenly referred to as the molecule of pleasure. It is more like the molecule of desire.

Our brain releases dopamine in anticipation of getting a reward, rather than on the actual receiving of the reward. That’s why the anticipation- of taking that drug, buying that thing, fulfilling that fantasy- is often so much better than the reality. And that’s why we keep craving more and more, even if the results are disappointing.

“Dopamine is not about pleasure, it is about the anticipation of pleasure. It’s about the pursuit of happiness rather than happiness itself.” Dr Robert Sapolsky.

In a study, described here by neuroscientist Dr Robert Sapolsky, monkeys were trained to recognise a signal. They knew that upon seeing the signal, they needed to press a button ten times, after which they received a tasty treat. The release of dopamine was measured in the monkeys’ brains. Dopamine was released as soon as the signal came, but ceased when the monkeys finished pressing, i.e. the dopamine release finished before the reward came.

Chart courtesy of Susan Weinschenk

Which drug is the most harmful?

This study, published in The Lancet, ranked drugs according to the harm done to the user and to wider society. It used 16 criteria including damage to health, mortality, damage to relationships, dependency, economic costs and crime.

It ranked alcohol as the most harmful drug overall. Although the study suggested heroin, crack and meth did more damage to the individual user, alcohol was the most harmful to wider society by a long way.

The study was conducted by Professor David Nutt, a former chief drugs adviser to the UK government. He was sacked after suggesting that alcohol and tobacco are more harmful than many illegal drugs, and that horse riding is more dangerous than ecstasy.

 

Addiction is more about pain than pleasure.

According to the self-medication model, addiction is a way of coping with pain or distress. In other words it’s more about escaping pain than pursuing pleasure. As such it’s no wonder that challenging and potentially distressing mental health conditions are conducive to substance abuse. A substantial proportion of people with addictions also have mental health conditions.

This chart shows, for example, that if you have ADHD or bipolar you are more than five times likelier to struggle with addiction than people who don’t.

This underscores the importance of asking: “What does the addiction do for you?” By understanding the function the drug serves, it’s possible to identify alternative, healthier paths to the same benefits people sought from their addiction.

The US opioid crisis

The scale of the US opioid crisis is staggering. Nearly 400,000 people died from opioid-linked overdoses from 1990 to 2017, according to data from the Centres for Disease Control and Prevention.

In 2017, an average 130 people died a day from opioid-related overdoses.

The seeds of the current crisis were planted by the over-prescription and aggressive marketing of opioids in the US in the 1990s and 2000s.

In 2017, for the first time ever, Americans were more likely to be killed by opioids than cars.

The lifetime probability of dying from opioids in the US in 2017 was 1 in 87, up from 1 in 451 in 1999. The probability of dying from motor vehicles dropped from 1 in 86 to 1 in 103 during the same period.

191.2m prescriptions for opioids were dispensed in the US in 2017.