Should the Addictions be Treated with Pharmaceutical Agents?Although he is a physician, Breggin (2008) has long been a criticof the pharmaceutical industry. For example, he observed that “Drugcompanies heavily promote the unproven speculation that theproblems they treat are biological in origin and result frombiochemical imbalances.” This is, as he points out, an unprovenhypothesis. It appears to be right, but sometimes the acceptedtheory is proven to be absolutely wrong. For example, 50 years agoevery physician knew that stomach ulcers were caused by stress. Thestandard treatment was antacids and possibly tranquilizers. Now itis known that the vast majority of ulcers are caused by bacterialinfections in the wall of the stomach and the standard treatment isa course of antibiotics and antacids to help the stomach liningheal. The “biochemical imbalance” is not automatically correct, itis just the most promising theory developed to date. However,nobody knows what a normal neurochemical balance in the brainactually is, much less how to achieve that balance. In spite oftheir “we’re here to help” public image, pharmaceutical companieswant to sell you more pharmaceuticals so they make a profit(Breggin, 2008). Through media campaigns, they attempt to makephysicians and the general public believe they need pharmaceuticalsto deal with life’s problems. While this is not to dismiss thebenefit of certain medications in the treatment of certaindisorders (such as hypertension, for example), do we needmedications to deal with all of life’s problems? People have foundways to cope with the problems of living for 10,000 generationsbefore the rise of the pharmaceutical industry. Why do theysuddenly need medications to cope? There is a rather interestingparadox inherent in the pharmaceutical treatment of a substance usedisorder, in that we attempt to medicate hypothetical chemicalimbalances in the brain, the exact nature of which we do notunderstand, with pharmaceuticals whose effects we also do not fullyunderstand. It is important to keep in mind that although marketedas treatments for specific conditions, the psychopharmaceuticalshave a blanket effect on the entire brain, not just the onesubsystem that is hypothetically malfunctioning. As a result, otherpharmaceutical agents are also used to treat various forms ofmental illness side-effects such as drowsiness, ataxia, etc.Breggin (2008) suggested that some of psychopharmaceuticals in usetoday cause lifelong damage to the brain. The basic premise ofpsychopharmaceuticals is that they disrupt the function of thebrain, hopefully in a more normal manner. The premise is the samefor alcohol and for the drugs of abuse, although they usually seekeuphoria. Surprisingly, from this perspective, it is possible toargue that the substance use disorders are attempts atself-medication by the abuser. However, we know so little about thenormal function of the brain that neither the current generation ofpsychopharmaceuticals nor any of the drugs of abuse are able toselectively dampen the function of just one region of the brain(Breggin, 2008). The medications impair the function of everyregion of the brain to some degree, leaving the question of whetherthey have “cured” the disorder, or just immobilized it behind achemical straight jacket, unanswered. These effects are “...theninterpreted (or misinterpreted) as improvements” (Breggin, 2008, p.1). When alcohol or illicit drugs are abused, the biochemistry ofthe individual’s entire brain is also affected, although it mightonly be observed in one domain of neurological function. Althoughthe reader might question the relevance of this discussion to theaddictions, it is important to remember that the substance usedisorders (SUDs) have been classified as medical disorders. Thepharmaceutical companies are searching for medications that can beused to treat the SUDs, and already existing medications are oftenbeing used “off label” to treat alcohol and illicit drug addiction.(Note: “Off label” is a term that refers to the application of apharmaceutical to a disorder for which it has not been identifiedas an effective treatment by the FDA.)

1. Are treatments using the pharmaceutical agents describedabove an improvement over the damage drugs of abuse cause to thebrain? Why or why not?

2 . Many patients neither want, nor will they accept,pharmacotherapy for their substance use disorders (Harris,Kivlahan, Bowe, & Humphreys, 2010). Imagine science discovers acompound that will eliminate the individual’s “craving” for alcoholor another drug of abuse with 100 percent certainty. Do we, as asociety, have the right to force such treatments on a patient, evenif they are effective? Who should be able to decide whatmedications an addict receives to help him or her escape from theaddiction?

3.Are the SUDs medical disorders, behavioral disorders thataffect the body (e.g., obesity), or a legal problem? Why? Whatimplications does your answer have for how the disorder/problem istreated?

4.Do you believe that the SUDs should be treated withpharmaceutical agents? Why or why not?