The Drugs Made Him Do It

I have argued against the analogy of drugs hijacking the brain as a way to understand addiction. There are too many dissimilarities between someone hijacking a car or plane and a person becoming an addict. With the analogy, an addict is both hijacker and the hijacked. But we don’t usually say a person hijacks her own car, for instance. Addictions take time to develop and a hijacking is usually a sudden event. I also expressed concerns about how this analogy construed responsibility. The hijacker is responsible while the people who are caught up in a hijacking not. The analogy seemed incoherent and ill-conceived. I concluded that we needed to retire that analogy.

Now a study just published online in JAMA Internal Medicine examined 1,580 reports of people in the United States and other countries who experienced pathological gambling, hypersexuality, and compulsive shopping after taking prescribed medications. In 710 of these cases, the people had taken dopamine agonist receptor drugs that are primarily prescribed to treat Parkinson’s disease though also used for restless leg syndrome and hyperprolactinemia. The link was strongest for pramipexole (brand name Mirapex) followed by ropinirole (brand name Requip). People with Parkinson’s disease become unable to produce their own dopamine. These drugs mimic the function of dopamine.

Somehow some patients get sent into overdrive when they take these drugs.

National Public Radio (NPR) reported that doctors at the Mayo Clinic reported eleven cases where people became compulsive gamblers. One man, who had only ever gambled once before in his life, lost $100,000. He also became fixated on internet pornography and engaged in extra marital affairs.

Neurologist Howard Weiss told NPR that at least three of his patients have lost their homes because of bankruptcy after taking these drugs as medically prescribed.

Once people stop taking these drugs, they return to their normal behaviors. It is hard not to see this as a hijacking. People were taking drugs as medically prescribed for a particular condition. The drugs produce a dopamine tsunami that causes an explosive amount of compulsive behavior over which the people had no control and in a sense, perhaps, no knowledge. And when the drug is no longer in a person’s system, she reverts to her usual behaviors.

So, it does seem as if there is a narrow category of cases in which it is appropriate to use the analogy of hijacking.

Does this analogy help those people who engaged in these compulsive behaviors and wrecked their personal relationships, financial security, or violated some of their core moral principles? Yes, hopefully in the sense that they understand that they were not the authors of their actions; some drugs induced compulsivity that overrode their other cognitive functions. Their actions were not freely chosen, and responsibility is mitigated.

However comforting that may be, they have to live with the aftermath of the damage. Their worlds have perhaps been shaken. Though a person may have reverted back to his “normal self” when he stops taking the drug, this self now confronts a very different world and has a lot more to deal with. As much as one may understand that a chemical storm in her brain caused her to act in these ways, this understanding may not be enough to help her make sense of all that has happened. It may not mitigate the guilt a person may feel for how he has affected his family or made them suffer. It may not undo the damage one believes she has done to her character. All of this can be utterly devastating.

An aside: The news article from National Public Radio has a very unfortunate title, "Parkinson's Drugs Can Be a Gateway to Sin." While perhaps meant as a joke or simply a matter of being unthinking, invoking the concept of "sin" is inappropriate because wields a hefty judgmental attitude.