November 28, 2021

I, Science

The science magazine of Imperial College

Matt Sargeant asks if addiction will still be a major societal problem by the 22nd Century, and whether pharmacology might have the answer

misuse 1971a borderAddiction is a chronic, relapsing disorder affecting two million people in the UK. It is a persistent disorder of brain function in which compulsive drug use occurs despite serious negative consequences for the afflicted individual. The initial impetus for drug taking is for the euphoria, but in chronic substance abuse, withdrawal of the drug often leads to antonymous symptoms that can be both psychological, such as dysphoria, and physiological, such as vomiting and shaking. This negative reinforcement drives the addict to seek out the drug to ameliorate the negative side effects associated with withdrawal.

Over 40 years ago, The Misuse of Drugs Act 1971 introduced penalties for the possession and consumption of prohibited drugs. The recent debate in the House of Commons on the effects of drug related abuse on UK society, highlighted that the UK government is spending £3 billion per year on counter productive measures against addiction, drug misuse and that the UK’s drug policies are failing. Consequently, the motion proposed to reassess the effectiveness of The Misuse of Drugs Act 1971, but will addiction remain a major societal problem by the 22nd Century?

A huge problem within addiction is the widespread, commercial distribution of alcohol and cigarettes. Both are readily available for purchase and consumption, despite their addictive and harmful properties. Arguably, steps have been taken to quell dependence with adverts encouraging consumers to be “drink aware” and a recent ban on cigarette displays in supermarkets, despite this, it is still easy to purchase alcohol and cigarettes.

The_Drunkard's_Progress_1846Alcohol is particularly embedded within our society. From personal experience, an enormous focus within the student community is around clubbing and consuming copious amounts of alcohol. To a certain extent, events like “Fresher’s Fortnight” glorify and encourage excess alcohol use. Although not everyone who consumes alcohol becomes dependent, an environment where alcohol is cheap and unrestricted creates a scenario where alcohol misuse is commonplace and addiction can emerge. Although smoking has decreased over the past several decades, as long as our laissez-faire attitude towards alcohol continues, alcoholism will remain alongside it.

Drug_danger_and_dependenceDrugs, such as benzodiazepines and opiates, legally prescribed by doctors are relied upon to treat illness, and have addictive profiles. Efforts have been taken to modify drug pharmacology so that the medicinal effect remains but the adverse effects, for example addiction, are diminished. Novel targets, such as potassium channels within nociceptive (pain) pathways, are being targeted in animal models with the aim of developing analgesic compounds without addictive properties. This research is particularly important as opiates and benzodiazepines also lose potency with long-term use. There is every possibility that by the 22nd century pharmacology will be sufficiently sophisticated to treat disease without the burden of addiction.

Some treatments are given with the knowledge that they are addictive. Methadone is prescribed to gradually wean addicts off heroin by reducing drug quantity until the maladaptive plasticity underlying the addiction is reversed. If habitual drug use is no longer a problem by the 22nd century, these treatments will be redundant. However, one of the issues addressed by the motion to review The Misuse of Drugs Act 1971, is that there is no link between drug abuse and the severity of penalties and from first-hand experience, I have found that some addicts view rehabilitation programmes as an opportunity to avoid prison whilst remaining indefinitely addicted. If there is little incentive to refrain from drug abuse then it will still exist by 2100.

PET scans of brains that are normal in comparison to brains of an obese subject, alcoholic subject, and cocaine user. Love is suggested to simulate patterns of a cocaine user in brain activation. (Wikipedia)

Addictions to gambling, exercise, sex, and overeating are inbuilt within human physiology and require no drug exposure, although the same changes in gene expression have been observed in substance abuse as in sex addiction, suggesting common dysfunctional pathways. These physiological behaviours are adaptations to our environment but, as human society has evolved, these behaviours have not, thus they have become maladaptive. Compulsive eating could be treated with novel drugs to reduce appetite and reducing the taboo around sex, as well as promoting a more open outlook on the subject, could help overcome sex addiction. However, as these are basic evolutionary survival instincts it is likely that these addictions will remain by the 22nd century.

As long as alcohol, cigarettes, and legal addictive drugs are available, together with illegal addictive drugs, then dependence will certainly be a problem by the 22nd century. Even in the complete absence of a drug, addictions to food, sex, gambling, and exercise still exist. If drug misuse legislation is more successful and pharmacology becomes more advanced, then perhaps addiction will disappear, but it appears unlikely that this will happen before 2100.

Images: Featured image, Addiction by C.P.; The Misuse of Drugs Act 1971; The Drunkard’s Progress, 1846; Drug danger and dependency; PET and human addiction