The Evolution of Addiction

This week, I focused a majority of my research time to reading a book written by my interviewee, William White. The book, titled Slaying the Dragon: The History of Addiction Treatment and Recovery in America, gives a very detailed account of the societal and political evolution of addiction and alcoholism, all the way from the late 1700s to modern day America.

What I found the most interesting after all of my reading was that as decades passed, social and political action against alcoholism, and more so, addiction, did not improve, but actually worsened. Even as recently as 1978, Dr. Sheldon Zimberg noted that "'physicians, psychiatrists, and other mental health professionals have been ineffective in the treatment of [addicts and alcoholics] and have lost interest in attempting to treat them'" (qtd. White 99). This disinterest in treatment coming from the physicians, accompanied by the government's extreme drug criminalization that was "driven by fear" (White 114), further ostracized alcoholics, and again, more so, addicts.

While this situation was bleak, the 20th century did come up with many different treatment techniques, some of which worked and some of which didn't. One of the most successful treatment methods was called "Aversion Therapy," which after being the strongest method for 60 years, paved the way for new approaches and treatments to be developed later in the 20th century. When in Aversion Therapy, the patient would be placed in a room void of anything except for a couple bottles of alcohol, a glass, and themselves. The patient was then giving a vomit-inducing drug so that when the patient drank the alcohol, the immediate reaction was to vomit. Additionally, administrators took great care to ensure that no positive feelings of intoxication reached the patient. So the patient would be in this room, alone with their thoughts, alcohol, and nausea. After repeating this for a set number of days, and repeated over a set number of months, the patient would naturally associate drinking with nausea and vomiting, which, in theory, cures the alcoholism.

While seemingly painful, this method yielded outstanding results. When followed-up with in the 1940s, aversion therapy patients reported recovery rates from 45% to 60%, substantially above the recovery rates for any other method in history. In his book, White mentions that this is likely because "all of the patients were voluntary and committed to the goal of permanently eliminating alcohol from their lives" (White 107), where in other methods, patients were often forced by family members or law officials.

Even though this is only the tip of the iceberg in the extensive history of addiction and alcoholism in America, it was a very interesting start, and I am intrigued to learn more as I continue to work on my Junior Theme.

"Big Bucks, Big Pharma"

As a part of my Junior Theme research this week, I was advised to watch something called "Big Bucks, Big Pharma: Marketing Disease and Pushing Drugs," an educational film that "examines how direct-to-consumer advertising of medications is a fairly recent innovation that has led to a sharp increase in the sales of prescription drugs." Although some parts of the film veered away from my "why" question, it definitely brought up many pertinent, interesting points that I had previously not seen. 

One of the strongest explanations it offered (for why such a large industry can get away with so much) was the relationship that the pharmaceutical industry, or Big Pharma, has with the FDA and the US Congress. According to the film, approximately 50% of the FDA's budget for approving drugs is funded by the very drug companies it's examining. Clearly, such a large amount of financial assistance would, and does, lead to a bias in the approval process. It also makes the FDA a "partner" of the industry it was formed to monitor, which greatly influences the integrity of the approval process. 

One speaker in the film also mentions how the "federal government has been coopted by the pharmaceutical industry." This makes sense, considering the FDA is a government organization under the US Department of Health and Human Services. But not only is Big Pharma directly involved with the FDA, it also "gives generously" to campaigns, and is the "largest lobby in Washington." All of this gave me a lot of insight into my topic, as it explains why the government would make the decisions they do when dealing with addiction treatment and prevention. Making a decision that would negatively affect Big Pharma (financially) would backfire on them, which is something no government or company wants to deal with. 

Since this film exhaustively analyzes what could be perceived as corruption in one of the largest industries in America, I hope to use this information in the section of my essay that explains/argues the financial impact or benefits of addiction treatment and prevention. 

America and Addiction

Throughout the course of this year, it feels like many of the topics we have studied in our American Studies class have been connected to the War on Drugs in some way or another. Whether the link was clear or vague, I thought it was interesting how significant a role this war played in current and past American society. Looking into it more, I wanted to find out what the government's role was, not just in arrests and incarceration (as we looked at in class), but in the more personal aspect of the Drug War: Addiction.

After a little bit of research, I came across a 2005 study that found this startling information: "Of the $373.9 billion spent by federal and state governments [on substance abuse], some 95.6 percent was spent to 'shovel up the consequences and human wreckage of substance abuse and addiction,' while only 1.9 percent was spent on prevention and treatment, 1.4 percent on taxation and regulation, and less than 1 percent on research and interdiction." 

Chart from the 2005 study, "Shoveling Up II: The Impact of
Substance Abuse on Federal, State, and Local Budgets"

This led me to wonder, why is this happening? Why is such a disproportionate amount of money being spent to "shovel up the consequences" of addiction, rather than actually treating the problem? (Especially considering States spend more on substance abuse and addiction than they spend on Medicaid, higher education, transportation or justice)

It turns out that there are many reasons (as would be expected), but probably the most significant is that addiction is lucrative. Much like how the lottery can profit off of gambling addicts, large pharmaceutical companies and doctors that specialize in addiction treatment profit off of substance abusers. And while there are many examples of this occurring, one of the strongest is the prescription and use of a drug called "buprenorphine" (also known as "bupe"). 

I plan to write a more in-depth blog on the controversy surrounding buprenorphine soon, but the gist of it is that buprenorphine is a "substitute opioid used to treat opioid addiction." Although there have been countless success stories showing how buprenorphine (often sold in a compound called Suboxone) was prescribed correctly and cured addictions (to drugs such as heroin), it still easily finds its way into corrupt, power-abusing hands. And once in those hands, we see doctors and research companies making thousands off of addicts (often by hiking up prices) who are only trying to find help. This benefits the government via the economy, which in the end, in why an insignificant amount of funds are allocated for combatting addiction (more addicts = more buprenorphine purchases = more money in more likely-to-be spender's pockets). This is only one reason for the disproportionality, but clearly, it plays a major role. 

As I continue my research, I hope to be able to really pick apart the government's reasoning for its decision-making. By the end and in the very least, I hope to be able to see a viable solution or improvement to an issue that has plagued America for far too long.