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Research Networks Network on Addiction Although it is hard to obtain precise prevalence statistics concerning addiction to alcohol and controlled substances, over 20 million Americans suffer from one of these addictions and large numbers of other citizens have difficulty managing their use of these substances. In 2005, 37% of prisoners in the northeast on probation suffered from substance abuse or dependence, compared to just over 8% of people in the general population. In addition, addicts are at risk for other mental and physical disorders. For example, needle-sharing is a major source of HIV transmission. Drug-related problems are also a major source of broken families and lost productivity. Some communities, especially poor and minority communities, are rendered anomic and dangerous by the drug trade and by addiction. Finally, other behaviors, such as compulsive gambling, that may usefully be labeled addictions also are related to many social pathologies. In short, the United States has a massive addiction problem that causes immense personal and social misery and cost. Addiction is commonly termed a disease among physicians and mental health experts, but the contemporary definition of addiction is entirely behavioral: persistent seeking and using of substances, often termed ìcompulsive,î despite severely adverse consequences. Psychological, social and biological interventions have all been tried, but all have limited success. Addiction is a notoriously relapsing illness. Successful intervention to date has been hindered by inadequate understanding of the causal mechanism of this very complex behavioral illness that has genetic, neural and psychosocial causes. Recent advances in neuroscience have the potential to revolutionize both our understanding of the neural roots of addiction and our treatments for this disorder. Based on solid experimental evidence, including persuasive animal models and the most sophisticated theorizing, it is now widely believed that addiction is in large part caused by the substancesí abnormal usurpation of the ordinary neural circuits of reward. These circuits ordinarily have crucial adaptation and survival value, but when they are ìhijackedî by substances, the result is the maladaptive misery outlined in the paragraph above. Such understanding has already led to promising biological treatments, such as naltrexone, a long-lasting opiate antagonist that may now be delivered in depot form. One can confidently predict that further research will produce ever more effective agents to help control addictions. No one denies that addiction also has important psychosocial causes, but neural interventions may well become the most powerful and cost-effective form of treatment for addictions, however they may be caused. Unlike psychosocial interventions, neurally-based treatments may be administered without the cooperation of the person being treated. At present, the legal system has failed to embrace a fully medicalized view of the addictions despite being encouraged to do so. In Powell v. Texas, 392 U.S. 514 (1968), the United States Supreme Court was asked to ìconstitutionalizeî a loss of control defense to the crime of public inebriation based on the defendantís suffering from the disease of alcoholism. Justice Marshallís plurality opinion noted the controversy surrounding the definition of alcoholism and was unwilling to hold that criminalization of behavior symptomatic of alcoholism was necessarily unwise or offended the constitution. Powell is still good law, and although many jurisdictions have diversion and treatment programs for addicts associated with the criminal justice system, the criminal law is still willing to hold addicts responsible for criminal behavior produced by and associated with addiction. Similarly, in civil law, although there are commitment programs for substance abusers, most people suffering from alcohol and illicit drug abuse are not forced into treatment. In other words, the law and much public opinion still treats addictive behavior as a moral rather than a medical or biological matter. Neuroscience will unquestionably put increasing pressure on the moral model of addiction and promote biologized understanding and response. For example, many people convinced by the biological model think that addicts should not be held responsible for their addictive and addiction-related behavior. It has been recommended that legislatures abandon criminalization of certain types of drug-related behaviors and replace it with mandated civil treatment. Use of the leverage of potential criminal punishment has been tried as a means to compel addiction treatment and thus to reduce drug-related recidivism. The proposed Network on Addiction and Antisocial Behavior will focus on the implications of new neuroscience for the legal response to addiction and related antisocial behavior. In addition to the foundational legal and philosophical research, we will also devise or contribute to neuroscience experiments that bear on the responsibility of addicts and their amenability to sustainable, successful treatment. The following experts have tentatively agreed to serve as members of a MacArthur Network on Addiction and Antisocial Behavior: Neuroscientists
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