The Heart of Addiction

How psychology drives addictive behavior.

Legalization of Marijuana Is Okay

Colorado and Washington will be fine

Readers of this blog know that addiction is a psychological symptom, a compulsive behavior driven exactly like other compulsions, and readily understandable and treatable. This perspective can be helpful in thinking about the recent election, in which two states legalized the recreational use of marijuana.

Legalization of marijuana has been opposed for several reasons:

• It has been believed to be immoral to use drugs

• There are health and injury risks to individuals

and society (e.g. motor vehicle accidents) related to the use of marijuana

• Marijuana is believed to be a “gateway drug” that will lead to use of stronger drugs and higher levels of addiction.

Proponents of legalization point to reasons of their own:

• The failure of the “War on Drugs” to reduce drug use or the problems it causes

• The cost to society of fighting this “war” (estimated at a trillion dollars since the 1970’s)

• The increase in prison populations and cost of imprisoning so many people

• The enabling of violent criminal drug cartels whose income would be destroyed if their product were made legally available.

• It is nonsensical to criminalize marijuana when alcohol and nicotine are legal.

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Understanding addiction as a psychological symptom allows us to do something that is rarely done in this discussion: separate the drug from its use, and its use from addiction.

Addiction is addiction no matter which substance or activity comprises its “narcotic” – alcohol, other drugs, shopping and eating can all act in the same functional way. This is the reason that so many addicts switch throughout their lives from one drug to another, or even from a drug to a non-drug addiction like gambling. It is nonsensical to speak of such people as being “dually addicted” or even being multiply addicted; the inner engine of addiction—its meaning—is consistent for each individual, namely an effort to relieve feelings of being trapped or helpless and to establish a sense of control. “I may not be able to tell off my boss,” is a common example, “But by God I’m going to have a drink or have a joint, and nobody is going to stop me.”

All compulsive or addictive behaviors are substitutions, or displacements, for a direct action that is felt in some sense to be impossible or forbidden. The particular form this substitute action takes can be almost anything. The “War on Drugs” is not just a misnomer; it reflects a real failure to understand that addiction lies in the individual psychology of each person – why he uses the drug – and not in the nature of any, or all, drugs. (Of course, one can develop physical dependency through the heavy use of certain drugs, but as I have described before, physical addiction has little to do with the problem of addiction. Likewise, the notion that drugs cause brain changes which produce addiction in humans has been amply disproved.)

Naturally, increasing the availability of any drug will increase its use and will increase the problems arising from that use, with or without addiction. If marijuana were more widely used, for instance, some people will drive while intoxicated on marijuana exactly as people do now with alcohol. From this standpoint it makes as much sense to criminalize alcohol as marijuana.

And yes, if more people have access to marijuana, then a portion of them will also use it addictively or compulsively, again like alcohol. But will this increase the total number of people with addictions? For that to happen there would have to be individuals who begin compulsively using marijuana but who have no prior addiction. While some people might shift to marijuana from other addictive focuses, there is little reason to think that people without any emotional need for addictive behavior would develop that need because of availability of marijuana.

Okay, but what about the “gateway” idea? This notion assumes that once people use marijuana they will seek a more potent drug. But recreational use of any drug, as with alcohol, does not create a need to move on to other drugs. There should be no surprise here; the psychological purpose of the addiction may be completely satisfied by marijuana. In fact, there is no reason to think that heroin would do a better job, and it could well do a worse job if people experience the drug effect as disempowering. (“I need to get some relief so I drink or smoke pot, but no way do I want to be a junkie”). Part of the confusion is that many people who use harder drugs started with marijuana, but this is simply the well-known “post hoc ergo propter hoc” fallacy: just because B follows A does not mean A caused B. Saying that earlier use of marijuana led to later use of heroin is like saying that since 90% of bankers had tricycles as a child, tricycles lead to banking. In fact, a recent study in the American Journal of Psychiatry following a group of young boys into adulthood found no basis for the idea that marijuana was a “gateway” to later drug use, fitting with what we would expect from a psychological perspective.

If marijuana ever became completely legal, then it is likely that more people would use it. It is also likely that some ill effects would occur from that use. There may be a few more people who use marijuana addictively, but it is unlikely to catalyze a major shift away from current addictive use of alcohol or other compulsive behaviors, and it is unlikely that the total number of people with addictions will rise significantly. There is also little reason to fear that it will lead to increased use of more potent drugs. Parents and teachers would need to counsel their children about marijuana use just as they now do about alcohol, but those kids will develop in more or less the same world we occupy today with alcohol.

And we could save some of the estimated 75 billion dollars we spend yearly on the War on Drugs and put that money into replacing a failed and outmoded drug treatment industry with a more sophisticated psychological approach.

Lance Dodes, M.D., is an assistant clinical professor of psychiatry at Harvard Medical School.

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