Surgeon General’s drug addiction report “marred by a biased viewpoint”

Summary and Analysis…

The Surgeon General’s “Facing Addiction in America” report was published in November 2016. It largely advocated a disease-model approach to addiction and the use of more drugs to treat it.

This paper, published in the journal of the Society for the Study of Addition, counters key aspects of the Report by identifying assumptions that were “depicted as facts in the Report” but are in fact “controversial” resulting in a finding that is “marred by a biased viewpoint.”

Excerpted from Addiction Biology

The Office of the Surgeon General recently produced its first Report on the consequences of alcohol and drug abuse on health, making several very laudable policy recommendations. The Report also emphasizes the importance of adequate funding for biomedical research, which is good news for both researchers and patients. However, the Report is marred by a biased viewpoint on the psychology and neurobiology of drug addiction. We highlight here four controversial issues that were depicted as facts in the Report, thereby potentially misleading non-expert readers about the current state-of-the-art understanding of the psychology and neurobiology of drug addiction. It will be important to recognize a fuller range of scientific viewpoints in addiction neuroscience to avoid amplifying this bias in the coming years.

A biased scientific viewpoint

However, the Report falls short in meeting its stated aim of ‘bringing together the best available science’ regarding the psychology and neurobiology of drug addiction.

Addictive drugs are not the same

The first issue is that the Report seemingly endorses the notion that the reinforcing effects of all addictive drugs are essentially the same, that is, they depend on the activation of dopaminergic systems of the brain. However, the available evidence does not support this claim.

Dopamine and pleasure: an out‐of‐date notion

A second issue concerns the nature of drug reward. The Report appears to equate the reinforcing effects of drugs (which refer to changes in the frequency of a behavioral response, as acknowledged on pages 2–8) to their pleasurable/hedonic effects.

Stress, CRF, and addiction: a target failure

The Report focuses much attention on the importance of stress in the development of drug addiction, and great prominence is given to the role of the stress neurohormone, corticotropin releasing factor (CRF), as the brain mechanism of drug withdrawal distress and cause of excessive drug use and relapse. There is little doubt that exposure to acute or chronic stress plays a significant role in drug addiction and relapse (Shaham et al. 1996; Badiani et al. 2011). Furthermore, studies using animal models have demonstrated a critical role of CRF in stress‐induced drug seeking (Shaham et al. 1996; Badiani et al. 2011), leading to the hypothesis that CRF plays a key role for in drug and alcohol dependence (Heilig & Koob 2007). Yet to date, all attempts at developing CRF‐based therapies for human addiction (or other psychiatric disorders) have been unsuccessful (Schwandt et al. 2016; Shaham & de Wit 2016), and major pharmaceutical companies have uniformly abandoned their development programs aimed at this target. The fact that no reference to the known failures in targeting this mechanism was made in the Report provides the readers with an unbalanced picture of the state of research in this area.