Dr Sederer is Adjunct Professor, Department of Epidemiology, Columbia University Mailman School of Public Health, Distinguished Psychiatrist Advisor to the New York State Office of Mental Health (OMH) and Director, Columbia Psychiatry Media.
We owe to American psychologist, Dr Bruce Alexander, the understanding that addiction is about far more than any drug. That a person, or animal in his studies, is an active ingredient in their interaction with a drug. To stand a chance beating the opioid and other drug epidemics we have, we will be far better equipped if we follow his lead.
Alexander’s experiments, in the 1970s, have come to be called the “Rat Park.1 Researchers had already proved that when rats were placed in a cage, all alone, with no other community of rats, and offered two water bottles—one filled with water and the other with heroin or cocaine—the rats would repetitively drink from the drug-laced bottles until they all overdosed and died. Like pigeons pressing a pleasure lever, they were relentless, until their bodies and brains were overcome, and they died.
But Alexander wondered: is this about the drug or might it be related to the setting they were in? To test his hypothesis, he put rats in “rat parks,” where they were among others and free to roam and play, to socialize and to have sex. And they were given the same access to the same two types of drug laced bottles. When inhabiting a “rat park,” they remarkably preferred the plain water. Even when they did imbibe from the drug-filled bottle, they did so intermittently, not obsessively, and never overdosed. A social community beat the power of drugs.
I believe that the biggest problem with the powerful, ubiquitous psychoactive drugs (meaning those that work on our brains and minds), is that they are so effective. In immediate and powerful ways, they change how we feel, think, relate, and behave. Or transport us away from loneliness and isolation. That is why we use them! It is also why campaigns of “just saying no” are naïve and ineffective, and why the dilemma of drug-taking, legal and illicit, has become one of the most dominant societal dilemmas we face in the 21st century.
The rates of overdose deaths, especially but not only from opioids, in this country continue to climb. In my earlier article, I described how prescribing clinicians can help people stay alive—until they enter an effective, individually shaped, recovery program.2 This article means to convey that there is a totally low-tech way of enabling people with addiction to (figuratively) prefer to ingest water rather than addicting drugs.
What we can do, a needed and effective approach, derives from what has Alexander taught us. Humans, not just rats, need to be part of a community, encouraged to relate and experience the support of others. This is about as basic a psychological truth as exists, yet does it find application in clinicians’ offices?
The author reports no conflicts of interest concerning the subject matter of this article.
1. Alexander BK, Beyerstein BL, Hadaway BF, Coombs RB. Effect of Early and later colony housing on oral ingestion of morphine in rats. Pharmacol Biochem Behav. 1981;15:571-576.
2. Sederer LI. The medical irony of the deadly opioid epidemic. Psychiatric Times. May 15, 2019. https://www.psychiatrictimes.com/substance-use-disorder/medical-irony-deadly-opioid-epidemic. Accessed May 30, 2019.