How NIDA put the “dope” back into “dopamine”

By allowing theories about brain function to trump facts about behavior.

Probation supervision with random drug testing and swift, certain, mild sanctions for every instance of detected drug use – HOPE – reduces drug-taking about 85% in a population of criminally-active long-time methamphetamine users, as demonstrated in a Randomized Controlled Trial with 500 subjects.  Those results – based on an archived dataset available for inspection and re-analysis by anyone who wants to look at it – are now being replicated in other trials in other jurisdictions.

The Director of the National Insitute on Drug Abuse – supposedly a scientific agency – tells the BBC that, because drug-taking alters the brain, “the threat of a judicial punishment cannot stop drug-taking.”

Unsurprisingly, applications to NIDA for HOPE-related research have all been rejected.

 

 

Author: Mark Kleiman

Professor of Public Policy at the NYU Marron Institute for Urban Management and editor of the Journal of Drug Policy Analysis. Teaches about the methods of policy analysis about drug abuse control and crime control policy, working out the implications of two principles: that swift and certain sanctions don't have to be severe to be effective, and that well-designed threats usually don't have to be carried out. Books: Drugs and Drug Policy: What Everyone Needs to Know (with Jonathan Caulkins and Angela Hawken) When Brute Force Fails: How to Have Less Crime and Less Punishment (Princeton, 2009; named one of the "books of the year" by The Economist Against Excess: Drug Policy for Results (Basic, 1993) Marijuana: Costs of Abuse, Costs of Control (Greenwood, 1989) UCLA Homepage Curriculum Vitae Contact: Markarkleiman-at-gmail.com

8 thoughts on “How NIDA put the “dope” back into “dopamine””

  1. There is going to be Vatican-worthy resistance to recognizing, acknowledging, and implementing the HOPE protocol. Ever since reading “When Brute Force Fails…” I’ve been talking about HOPE and 24/7 Sobriety to folks I work with in treatment, and I’ve found a knee-jerk refusal to even consider the evidence, from twelve steppers to hard left, pro-legalization liberals. I’m not surprised – HOPE completely invalidates (demolishes?) three hundred years of cultural and social mythology, the latest iteration being the ‘disease’ model. If the most severe forms of dependence can be stopped cold by relatively simple behavioral modification, what does this do to a system that’s intrinsically invested in either demonizing or pathologizing folks who use and abuse drugs? If the amazingly similar success rates of test/punish with HOPE, 24/7, and doctors – widely different populations using completely different classes of drugs – tell us anything, it’s that drug abuse is heavily reinforced behavior. Period. Full stop. End of story. No demonizing or pathologizing necessary.
    So I’m not surprised at the resistance, really. Tens if not hundreds of thousands of LCDC’s and treatment staff will be out of a job. Entire research departments will be useless. Many if not most of those wildly expensive and ineffective treatment centers – see ya. Government agencies who’ve bet the farm on the ‘disease’ model suddenly look really, really stupid and pointless (and lose their funding). Pharma loses a huge chunk of change, our ever-vigilant drug warriors lose they bete noir; if drug consumption craters a central mythology of America’s dark side takes a direct hit – and with it goes billions of dollars of licit and illicit blood money. Plus, if we fix our drug problem, especially with such relative ease and lack of pain, then it becomes that much harder to ignore the real issues of social and economic injustice that lie at the core of this country’s decay.
    So yeah, they’re going to defame, belittle, undermine, dismiss, sneer, reject, slap, bite, scratch, kick…. the folks who are actually suffering from uncontrolled drug use? Expendable. We have a massive and massively profitable illusion to uphold, an particularly vile illusion in which well-paid, very concerned parasites get to claim the high holy ground over the poor unfortunates whose brains have been, apparently, distorted beyond rescue. Forgive me father, for I have sinned……

    1. I think that’s going a bit far, and not giving treatment-inclined people enough good faith. But much of what you’ve said is no doubt true. I think much of what you have described has arisen from a lack of awareness of better alternatives. I think if HOPE indeed is a better model, those truly interested in seeing people get clean and have more agency in their lives won’t be hard to convince. I’ve worked in social services most of my life and have always welcomed the thought of being “put out of a job” so to speak. As ever, I think its important that we not paint with too broad a brush, and instead focus our attentions on specific – and real – levers of intransigence.

      1. I agree that my late night polemic paints a broad swath. If it seems as though I’m frustrated, I am. Week after weekI have to go through the motions with folks who know as well as I do that what we’re doing is a waste of time and money. Many if not most of our clients have no business in treatment, and the ones who really need help are for the most part not getting it through the standard model. Much of my frustration stems from spending the last three years in treatment of adjudicated offenders, exactly the population addressed by HOPE, and seeing firsthand the near total ineffectiveness of standard treatment models with this population. I have not worked in voluntary programs, so I can’t comment on their effect or efficacy, but having read and internalized Gene Heyman’s compelling documentation (based on exhaustive, large scale studies) that at least 75% of those meeting the criteria of substance dependence resolve without seeking treatment, plus the amazing effectiveness (about 85%) of HOPE et al, plus my own experience with hundreds (at least 500, and counting) of adjudicated adolescent and adult clients, the vast majority of whom presented and reported a lack of effective response to treatment, and I can’t help but think that the treatment model as it currently stands – in particular the 12 step model – has extremely limited utility, relevant at best for a very small percentage of those with drug related problems. Even when I have seen positive responses from clients, it’s almost invariably from effective interpersonal therapy. For adolescents in particular it’s a fool’s errand to pursue standard substance use ‘treatment’; I’ve found the most effective path is build the both the parent/child relationship and client internal and external resources – in other words, family therapy and social work, not ‘treatment’. In fact, I’ve had many, many teen clients tell me straight up that ‘treatment’ actually makes them want to get high, and I’ve seen this documented in the literature (re: Keith Humphrey’s volume on this website, where some good research shows it’s counterproductive to even talk about drugs with teens, exactly congruent with my experience). For adolescents in particular, then, the evidence seems compelling that treatment as usual simply does…not…work.
        I think Mr. Kleiman has hit the nail on the head, in that treatment is probably best seen as an adjunct to natural recovery and first line programs such as HOPE. This, then, drastically reduces both its scope and applicability. Not a moment too soon, in my opinion, because this represents one small step away from this country’s Calvinist obsession with demonizing and/or pathologizing those who use drugs. In a very real sense, whether it’s hysterical, hypocritical opprobrium or holier than thou ‘concern’ for those poor ‘diseased’ unfortunates, folks who choose to utilize psychoactives are seen as “not us,” relegated to inferior status in order to prop up America’s decaying exceptionalist mythology. (Not to mention that the vast majority of those who’ve come through my programs are people of color.) So, yeah, I sincerely hope (ha, ha) that HOPE slays the ‘treatment’ dragon. Can’t happen too soon.

  2. I think that with the right framing, something like HOPE can fit fairly well into the disease model. Look at the kinds of diseases, for example, where Directly Observed Therapy has cut prevalence significantly. But it’s going to take a lot of work.

    Do we have any kind of sensitivity analysis for HOPE and similar programs? How badly can you underfund them or mis-implement them before the results get as bad as conventional approaches?

  3. I recommend a charm offensive. Send the guy autographed copies of the book — signed by all the authors. Throw in some dark chocolate truffles. Flatter the sh*t out of the entire NIH if that’s what it takes.

    Hey, why not hire a lobbyist of your own? Or grab some out of work college kids and send them across the country in a van, doing something related and eyecatching. (No thoughts just now on what that might be.) They can tweet, and what-not. Think big, Mark!!

    1. Actually, bleep the charm. What about looking closer to home? Is there any state funding for this kind of research? Because we do happen to have some pretty excellent executive officers here in California. I don’t know quite by what miracle this has happened, but why not take advantage? The AG is smart on crime, and we have the best governor of our lifetimes, probably.

      It’s too bad you can’t somehow involve some stem cells. Because maybe then, there’d be money.

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