Sadly, There is No Magic Bullet

Drugs—we love them. We've come to believe in a prescription for every condition and a pill for every ill. Industry advertising tells us what doctors should prescribe for a catalog of ailments, real or imaginary. And this pharmacological boom has proven particularly creative and bountiful in the treatment of addiction.

Advances in brain science have given us a new understanding of addiction and its neurological basis. They have made possible a spectrum of anti-drug drugs. The latest of these, now in development, are vaccines that may be able not just to treat addiction but to prevent it as well. These vaccines would train the immune system to recognize psychoactive substances that now slip unidentified into the bloodstream (cocaine, for example) but, when identified, can be destroyed before they can reach the brain.

It sounds great. And the new medications will have their place as treatment protocols evolve. In our passion for the prescription quick fix and pharmacological solution, however, we should recognize that drugs alone are not the answer to addiction.

The law of unintended consequences warns us that there's a downside to just about every advance. So discovering that addiction involves profound changes in the brain has led to a widespread assumption that addicts are powerless over their condition—that drugs have hijacked their brains. This, in essence, rules out free will and the possibility that some addictive behavior may be voluntary. It is a seductive proposition, for it suggests that the addict is incapable of self-control, and hence cannot be responsible for his or her behavior.

It is clearly true that addicts become increasingly incapable of controlling their behavior, for the compulsive nature of their drug use is the defining characteristic of their addiction. Moreover, addiction is far from an equal opportunity affliction. Certain individuals—by heredity, mental illness or age—are far more vulnerable than others. There appears to be a genetic component to addiction, and a substantial proportion of addicts suffer from co-occurring mental illness. As parents and policymakers, the vulnerability of teens rightly concerns us most, for the adolescent brain is a work in progress. While the brain's pleasure- and sensation-seeking center is up and running strong at puberty, that portion of the brain exercising control over impulsive and irrational behavior isn't yet fully hooked into the mental communication system until the mid-20s. Lives can be destroyed before they even begin.

My work—I founded Phoenix House, the drug and alcohol treatment program, 40 years ago—and the work of my colleagues would be much easier if the brain were the sole culprit in addiction. As jarring as it can be to say this in a milieu constantly shaped by reports of new scientific insights, it must be said: biology is not necessarily destiny. To accept the proposition of an addict's powerlessness is to eliminate volition from the equation, for we know from hard evidence that addicts can and do kick the habit. And, no matter how difficult it eventually becomes to exercise choice, there is always a period at the outset when choice is not only possible but relatively easy.