Cutting The Gordian Knot of Drug Addiction Confusion
Strategy of Seduction vs. Seduction of Strategy
Dr Stuart Reece, General Practitioner in Brisbane, Australia

We know that methadone is the best drug used in addiction treatment.  Therefore our only problem in addiction medicine is that we do not have a methadone for all the other drugs of addiction.
Leading Science Administrators in Australia and USA

“I didn’t inhale”
Bill Clinton quoted in an addiction medicine textbook commissioned by the Academic Deans of Australian Medical Schools (1)

It’s not about drugs
Present work

Conceptual Understanding of Addiction
On 1776 Thomas Jefferson penned the immortal words that “men…were endowed…with…inalienable rights…among these are life, liberty and the pursuit of happiness” not only into the founding document of the United States, but in time, into the very basic fabric of the cultures of the Western world.  The pursuit of happiness has come to be accepted as the fundamental right of every breathing and living human on the planet in the free nations of the world.

At the conceptual level Jefferson’s famous phrase also, albeit to be sure unwittingly, boldly underscores the apparent contradiction at the heart of the drug debate.  An enormous body of evidence now exists from the modern neurosciences demonstrating that addiction unequivocally stimulates the pleasure system of the brain in the limbic structures, the extended amygdala and the pre-frontal cortex (3),(4).  This leads to an immediate conclusion, supported by many and funded by the mighty, that since drugs make you happy, the chief end of government is to supply as many drugs as often as possible and in any imaginable amount to all who may wish to partake of their all too obvious pleasures; or at the very least not to interfere with those who might wish to do so.  If the fast way to achieve the idyllic state referred to by Jefferson is simply to “get stoned”, “get wasted” or “get high” then why not go right ahead?  In particular since this is an inalienable right of every man, then surely our personal liberties demand just this, particularly if it can be done in a manner which does not interfere with the pleasure seeking endeavours of others?  Or could there be more to things than the simplistic libertarian argument so many want to hear?

Surely the siren voices of the maidens of pleasure cannot always lure life’s unwary travellers onto the rocks of destruction and drug induced destitution?
 
Surely to believe the line that unbridled hedonism is the ultimate social virtue, one must accept the premise that the seduction of our desire for pleasure and relaxation is the ultimate social good.  It would follow that a society totally consumed with pleasure seeking is the chief end of human existence and the very pinnacle of social organization.  Indeed, historians who have reviewed this subject repeatedly find that societies caving into the seduction of unbridled pleasure and sensuality are on a usually rapid social decline, punctuated by all forms of social decadence and depravity.  The strong and almost invariable link between decadence and social decay has been documented by, amongst others, the Father of American Sociology, Pitirim Sorokin (5).  The same is obviously true today, in every area where addiction is commonplace, in every large city centre troubled by addiction, ghettoes and gangs, in every remote mountain village from Morocco to Cuba to Afghanistan to Colombia to Amsterdam where drugs run riot, so too does a myriad of commonly associated social, medical and criminal pathologies. 

Patients readily acknowledge their love/hate relationship with their drug of choice.  The clinical course of the addiction seems to be a dynamic cost/benefit equation.  In other words when the trouble caused by the addiction is too severe patients cry out for help – often not for the addiction itself, but for its effects.  Those around them hope that this will lead to a definitive address of the underlying issue, but this is often only temporary.  Memories of bad experiences mellow and fade with the passage of time.  As the patient moves into sobriety and life improves, the delusions that “I am stronger now”, “I am over it now”, “It won’t happen again”, “I can control this now”, and especially “One taste won’t matter” start to grow.

Why is addiction defined in countless textbooks as a “chronic relapsing disease”?  Why do our patients always return to their substances despite numerous detox episodes?  What is it about the addicted personality which is so different?  Why can one person have a social drink, but another’s life is totally consumed by the “demon drink”?  Given that trouble is common to all humanity, why do some apparently choose to drown their sorrows in the bottle or the needle?  Given that hospitals normally use narcotic painkillers for post-operative analgesia, why are some people’s lives consumed by that sensation, whereas the great majority of patients leave hospital and re-commence their lives?

A dramatic way in which we can help patients understand this dichotomy is to ask them if they have children, or if they hope to have them.  Generally, the response is affirmative.  Then one asks them how they would feel if we were to seek to administer their drug of choice to their child.  Of course they object strenuously.  One patient calmly told me that he would have to kill me.  We then have a scenario where for the adult the drug of choice is the most wonderful thing in the world and the thing to which their whole existence has been devoted, whilst for the child this drug represents the very quintessence of evil, absolute impurity, destruction, non-life and often a horrible, lonely, awful death.  I point out that this represents two very different and in fact opposite views of the same drug.  Then I ask them which view is more likely to be correct, their own view or their view for their children?  They will generally agree that it is the view for their children.

In other words they themselves have been seduced by the lie of pleasure and personal seduction.  Their life does not work, and there is endless trouble and tragedy in and around them because their life has been devoted to serve the lie that their life is about themselves, their pleasures and their feelings – all of course via their drugs.  Hence the real issue is their perspective of the drugs – it is their seduction.  That is to say…

It is not about drugs.  It is about addiction.  When addiction is understood as a certain way of viewing drugs as the mainspring of life, then addiction becomes a very sinister and powerful – not to mention destructive - delusion.

To which the radical cure is clearly the truth: the truth as relates to themselves and also to life, which is likely why many of the most successful programs in the long term take a spiritual perspective on these problems.  They boil down fundamentally to a statement of belief.  Understood in this dimension, the statements “life is drugs” or “life is pleasure” are at once profoundly spiritual and profoundly false.

Use of the naltrexone implants dramatically divorces the drug use from the empty and chaotic life, underscoring this point (6-12).  Whilst naltrexone implants allow opiate use in opiate addicts to be arrested immediately, it does not necessarily restore virtue, value, direction, a healthy identity or normal emotional state.

The realty of the drug debate is that a few well financed and tightly organized groups have launched a largely highly successful strategic assault on the global traditions of drug prohibition which were introduced in the twentieth century in a pan-global response to the menace and predations of drug addiction on the peoples of diverse lands, particularly Egypt. 

Hence one observes a potent confluence between the siren voices of the seduction of pleasure – AKA “pragmatism” - (“everybody’s doing it”, “you will not surely die”, “just one taste won’t hurt”, “it's only recreational use” “it's not so bad if you snort it up or smoke it”, “its better if the government supplies it in pure form”, “provide clean free needles to reduce HIV spread”, “a clean fit for every hit”, “medical cannabis”, “heroin trials”, “shooting galleries”) and the strategic interests of the drug and addiction multinational criminal and associated corporations with a vested commercial or academic interest in the expansion of the drug trade.  Just as we saw the “long march through the institutions” which followed on as a sequel to the postwar alternative lifestyle era and the direct and deliberate enactment of a defined social agenda, so too have we seen a less well heralded, but even more obvious takeover in the West of the culture of pleasure.  One observes a confluence of a strategy of siren-like seduction of individuals and of peoples, and the quintessential seduction of the strategy of unbridled power.  This is particularly well displayed in the addiction arena with modern university based academic meetings in favour of drug liberalization with leaders in the profession from several nations commonly among the invitees.  The implications of this professional takeover are far reaching indeed.  It implies that irrespective of the result of major political events such as national elections, whichever government is voted into power is advised by the same academic elites apparently largely consumed with their own internal agenda.  In other words, government is at grave risk of being perennially mis-advised, with few administrations having the moral fortitude of the recent British government decision to reschedule cannabis from Class C to B in the face of oppositional expert advice.

At the risk of stating the obvious, addictive drugs, after all, are addictive.  This well known neuropsychological fact implies at the economic level that the demand for them is potentially infinite.  In other words, in contradistinction to most other goods and services there is a potentially limitless market for these agents.  This translates to virtually unlimited financial gain for those who can wrest control of this unbelievably lucrative bazaar.  This creates for many in key positions an irresistible allure of almost unlimited global economic ascendancy, including cultural and ideological domination.

Hence in this area one sees an organized global confluence of two powerful streams, the seduction of strategy and the strategy of seduction (particularly by the widespread use of misnomers and the dissemination of misinformation, disinformation and half-truths).  Nevertheless, as my patients have noted many times, to be overcome by seduction one must release one’s personal sovereignty to the object of one’s desire; and in so doing one is weakened.  Thus fundamentally at the spiritual level and subsequently at the medical, social, relational, organizational, employment and structural level, the addicted and the society which hosts them is progressively, inexorably and inevitably weakened.

It would appear that conceptualization of what might be broadly termed the “libertarian argument” for drug liberalization omits four key factors from its theoretical constructs.  As such it would appear to flounder irreparably on a real world “reality check”, and be irreconcilably out of touch both with common observed experience and modern scientific research alike, despite the obvious limitation of the largely inadequate research base on these subjects.  The areas of oversight of the libertarian view are:

• Addiction is by definition chemical slavery and weakens the individual;
• Addiction is demonstrably toxic;
• Addiction is highly contagious;
• Addiction’s effects are transgenerational;
• Addiction’s many costs are born in substantial measure by others.

It is appropriate to consider these in further detail.  Since the definition of drug addiction invariably includes persistent use despite adverse medical social and/or criminal consequences, the addicted may be rightly said to be in a formal sense “enslaved”.  Since slavery is the opposite of liberty, libertarian arguments may be formally said to be misplaced.  The fact that not all recreational users become enslaved by habitual use is irrelevant, for virtually all habitual users were at one time small time users.  Recreational use is perhaps one of the highest risk categories for the enslavement of habitual use.  Without the recreational pool, there would be no filling up of the heavily addicted pool with its high attendant death rate.

Secondly, addiction is toxic.  Modern science is beginning to describe some of these toxicities of extended exposure to drugs of abuse, and the extension of the concept of liberty to self-poisoning is at best controversial, particularly if it predictably results in unhappiness.  In particular, the toxicities of addiction can be chronic or long term.  They may be in part reversible with cessation of use, although this area is not well studied.  It is also likely to exacerbate pre-existing pathologies including medical, social, psychological, criminal and employment/employability factors.   

Thirdly, addiction is socially contagious as the drugs are usually shared and bought and sold with friends.  This is especially true amongst sexual intimates who frequently cannot resist the allure to share the altered sensorium their partner is experiencing.  In this sense, addiction is socially and sexually contagious.  That it is also associated with the transmission of sexually transmissible diseases including genital ulcerative disease and HIV compounds these associations.  In view of the extreme social infectivity of addiction, one might ask “What are the libertarian rights of the untreated plague victim?”

Fourthly, there is literature demonstrating that many of the effects of addiction are passed on to offspring of exposed mothers and sometimes fathers. Surely the libertarian philosophy extends to newborns the right to a normal birth, start in life and developmental stages uncomplicated by known exogenous neuro- and somato- toxins?  The pattern one observes repeatedly is that the most disadvantaged parents who are least able to cope with unruly, hyperactive, difficult or chronically unwell children, are the very parents who produce just such children, who themselves become enormously disadvantaged by both in utero and post-natal exposures including a frequently deprived and neglected upbringing.

And finally, since mental and physical illness has been demonstrated to be part of virtually every established chemical addictive syndrome, this combination of long term poor physical health, frequently with long term mental health issues, reduces or completely abolishes the capacity of the addicted to care for themselves and their loved ones.  They therefore become a burden on the welfare system, the health system, the child welfare systems, the mental health care system as well as the criminal justice system.  Indeed, one recent and very thoughtful study demonstrated that long term opiate dependent patients are likely to require geriatric medical and general gerontological care prematurely (13).  Hence, far from being an individual libertarian issue, the addiction of the individual becomes a major cost to the other members of society which is borne in many dimensions.

It is this inadequate understanding of addiction both conceptually and at the toxicological level which underlies the making and the publication of the opening quotes such as that from leading science administrators in the USA in relation to methadone and a remark usually attributed to Bill Clinton (“I didn’t inhale”). Of even more concern is Clinton’s being quoted in a textbook designed for Australian health professionals studying in the area and commissioned by the Committee of Academic Deans of Australian Medical Schools, arguably the highest medical authority in the land, and its use in the opening introduction to the chapter on cannabis 1.

The Australian Paradox
Australia is frequently said to have done exceptionally well amongst the global family of nations in the effort to reduce its cigarette smoking rates.  Based on our national drug strategy household surveys, rates of daily cigarette smoking fell from 33% to 21% 1985-2004 in males and from 30% to 18% 1988-2004 in females (14).  Advertisements describing the effects of smoking have appeared on prime time television, are seen on highway billboards and are plastered obviously on the front of cigarette packets themselves where they take up more than 25% of the front of the packet.  Depicted scenes include black gangrenous toes, lung tumours, atheromatous arteries with thick pasty pultaceous material exuding from one end of a frankly diseased aorta, patients on oxygen gasping for breath, and pregnant abdomens with remarks about baby being too young to smoke.  Medical treatments for nicotine dependence are available over the counter in pharmacies and at federally subsidized rates on prescription through any family doctor.   All this has been achieved in only a few short years following the major tobacco company settlement.  In the field of tobacco primary and secondary prevention then, Australia showed that it can be done. After all, “everybody knows.” 

It is therefore a matter of great curiosity and perplexity that this same nation is also amongst the worst in the developed world for the use of the illicit drugs heroin, cannabis and amphetamines (15), (16).  Cocaine use here is lower than elsewhere, probably owing largely to our geographic distance from the major cocaine source nations and supply routes and the diminutive size of our domestic market.  Recent trends however show very strong and rapid growth in this drug also, albeit starting from a smaller base in the alternate community.

This stark and remarkable paradox sets up an extraordinary conundrum.  How can one of the best nations on the planet for tobacco be at the same time one of the worst nations for illicit drugs of addiction with probably the fastest growing cocaine market?

The answer, it would seem, is that when it comes to illicit addictive drugs in this country, “Nobody knows.”

And therein lies perhaps the greatest pearl of drug policy for the rest of the world.  For any nation to ride high and free from the global scourge of drug addiction, strong and forthright educational efforts must be paramount.  “Everybody must know.”

Here we do not.  The truth is hard to find, and the general public is kept in the dark.  The dominant ideology governing drug policy is harm minimization which openly condones both increased drug use (17) and full drug decriminalization (18); indeed, debate is often led by a well known group quite overtly entitled “Australian Drug Law Reform Foundation” (19).

Our domestic situation contrasts with that in Sweden, where drug education in schools is widespread and interwoven into many school curricula, and is also widespread in society.  As a result, Sweden has one of the lowest drug use rates of any of the developed nations.

A Plan to Advance – Research and Education
In comparison with the excellent public education which is readily and generally available in relation to tobacco, that relating to illicit drugs of addiction is, at least in this nation, abysmal.  However, the state of relative ignorance in the general populace directly reflects that within the professional and scientific community.  Despite the all too obvious evidence of rampant devastation in virtually every area of life in long term addicted patients, science in general has lagged way behind the obvious clinical evidence at the coal face in describing and characterizing the evident damage.  It is true of course that the effects of some neurotoxicities related to various drugs, particularly cocaine, are being worked out seriously and with a thorough going and determined investigational strategy by very fine schools 302-306.  Such can, in general, not be said for other addictive drugs particularly outside the central nervous system where it is likely that some of the most telling addiction related toxicology occurs.  A very dramatic example of this occurred this year in the USA where, despite cannabis decriminalization being widely discussed in many state legislatures, the voice of science (at least to this interested if distant observer) was conspicuous by its absence.  Considering that the NIH alone invests around $1 billion US annually in addiction research, that is outside of very considerable and well known American philanthropic bequests, one can only be staggered that so much investigative effort would apparently seem to be unrelated to the burning issues confronting that nation, and in reality, many others.

Hence, a rational plan for a way forward would be to use proven public health preventative techniques particularly related to widespread generalized popular education in this fight.  We have shown that it can be done in relation to even more prevalent substances such as tobacco.  Modern educational techniques can, of course, be quite sophisticated and include web based and interactive digital methods as well as traditional classroom based and popular methods described above for nicotine. The issue comes with the relatively deficient content presently available for publication.

Whilst the neuroscience is progressing reasonably well under its own steam by the usual methods of science, this does not seem in general to be true for addiction toxicological research related to other body systems.  Most experts trying to work in this area are quite agreed that many issues are clearly not receiving nearly enough research attention.  In my view it would appear that the most urgent issues facing a community genuinely concerned about the ravages of addiction on their young outside but not excluding the neuraxis would include:

1. Stem cell and tissue regenerative defects,
2. The implications of the progeroid immunomodulated profile, cytokines and CD56bright Natural Killer cells, particularly on stem cell populations and key organ systems,
3. Free radial fluxes – direct and indirect induction,
4. Genetic, including chromosomal damage,
5. Telomere (end chromosomal) damage,
6. Sperm and germ cell toxicology,
7. Mitochondrial pathologies.
8. Arterial structure and function,
9. Bony structure and function,
10. Dental disease, particularly immunology and gingival stem cell activity,
11. The ability of addictive drugs to induce premature ageing syndromes in model organisms such as mice,
12. Studies of micro-RNA,
13. Investigations of major age related pathways including Sirtuins 275, 307, 308, circadian genes 304, 309, 310, AMP kinase 311, sympathoadrenal stimulation, gonadal signals, P16, P19, P21, P53, Dec1, Mcl1 and DcR2 56, NF-kB 190
14. Neuronal – glial interactions in the context of addiction.

The pattern is that with the on-going rapid advances in biology important new biological systems are discovered every few months.  The obvious issue, if the toxicology of addiction is ever to be understood in detail, is for these various systems to be studied in the context of the various addictive drugs.

It would therefore seem that educational methods exist and are tried and well proven to have the ability to influence a population for good in relation to drugs of addiction.  The problem relates mainly to areas upstream of education, namely a block within the research community, to studying in a deliberate and determined manner, key areas of interest.  This block is related to the fallout of a long term academic strategy.

To my mind at least, the matter turns on our response to seduction, to strategy, and to the potent mix of the interaction of the two, in our general and scientific communities.  The present paper outlines a way forward for the international research community, should we possess the courage and will to pursue the course which is clearly required.  If we continue to take the “soft option”, we will inevitably be forced to pay a stiff price, potentially for generations to come.  We absent the outcomes of formal rigorous and thorough going scientific investigation from the popular debate at our grave peril.

Author Information
Dr Stuart Reece is a General Practitioner in Brisbane, Australia. His relevant expertise in the addictions field is based on 10 years intensive involvement in the treatment of addiction as the delegate of the Preventative and Community Medicine Committee of the Queensland Division of the Royal Australian College of General Practitioners and in a clinical practice in which he had (to mid 2007) been responsible for 8,044, or 73.2%, of the registered 10,987 opiate buprenorphine detoxifications in the state of Queensland (Queensland Health data 17/08/07). He is the holder of one of the best safety records for naltrexone based rapid opiate detoxifications internationally, with only 2 hospital admissions in 1,800 procedures. He has attended and presented at a large number of international conferences in addiction medicine and science and has conducted research on addiction medicine. He was recently appointed a Senior Lecturer at the University of Queensland and visiting scientist at the Queensland Institute of Medical Research (elect).

I declare that I have no proprietary, financial, professional or other personal interest of any nature or kind in any product, service and/or company that could be construed as influencing the position presented in, or the review of, the manuscript entitled
except for the following:

Naltrexone implants were sold at one time through this clinic for the use of patients undergoing treatment in this clinic.

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