Valuing the Pleasures of Drugs Is a Path to Sane Drug Laws
The FDA's decision to factor in the "pleasure measure" when weighing new cigarette regulations has sparked controversy. But drugs often make us feel great—and this is relevant to how we regulate them.
How do you measure the pleasure that you lose when you end an addiction? To most formerly addicted people, the question makes little sense because by the time they quit, it’s often been years since the benefits of the drugs in any way outweighed their negative consequences. However, pleasure is an essential part of life: It’s not for nothing that the pursuit of happiness is highlighted in America’s founding document. Including measures of pleasure is critical to regulating addictive drugs, in fact—but only if it’s done right.
This issue is now faced by the FDA, which, under federal law, must weigh benefits against costs when creating regulations and avoid making rules that are too expensive. The agency must calculate the value not only of health gains from reduced smoking rates, but also of enjoyment lost by smokers who quit. Not surprisingly, that sort of pleasure is difficult to quantify in dollar terms, as the FDA is learning to its dismay.
The government’s calculations recently caused consternation among antismoking groups, who claim that the agency has given too much weight to the hedonic “benefit” of smoking—and the loss of this that comes with quitting—in making its latest tobacco rules and rejecting the idea of graphic warning labels on cigarette packs.
Earlier this month, a group of heavyweight economists (including a Nobel laureate) released a critique of the new regulations as part of the public comment period required when new rules are considered. Here’s how the New York Times described it:
Buried deep in the federal government’s voluminous new tobacco regulations is a little-known cost-benefit calculation that public health experts see as potentially poisonous: the happiness quotient. It assumes that the benefits from reducing smoking—fewer early deaths and diseases of the lungs and heart—have to be discounted by 70% to offset the loss in pleasure that smokers suffer when they give up their habit.
Experts say that calculation wipes out most of the economic benefits from the regulations and could make them far more vulnerable to legal challenges from the tobacco industry. And it could have a perverse effect, experts said. The more successful regulators are at reducing smoking, the more it hurts them in the final economic accounting.
Described that way, the cost-benefit analysis includes measuring pleasure when regulating addictive drugs like cigarettes is pernicious. Reducing the financial “benefit” side of the calculation by 70% to “balance” the pluses of longer lives and better health against the “lost pleasure” of smoking clearly goes too far. Indeed, in their critique, the economists note that more than three-quarters of all smokers start their habit while underage, meaning that they are probably not making a completely rational consumer choice. It’s well-known that youth are not always good at linking their current actions with future consequences—and indeed, most young smokers believe that they will have quit long before they actually do so.
Antismoking groups say that the FDA has given too much weight to the hedonic “benefit” of smoking—and the loss of this that comes with quitting—in making its latest tobacco rules.
Moreover, the authors note that if smokers were making a rational choice about the benefits of smoking compared to its risks, the proposed graphic warning labels would have no effect—since the smokers would already have taken into account the risk of cancer and other gruesome outcomes. They suggest instead applying that 70% discount only to the 9% of smokers who say that knowing what they now know about tobacco, they would still choose to start smoking.
But while the way the FDA did its calculations here is troubling, we shouldn’t entirely reject the idea of including pleasure in calculating the viability of a particular drug policy.
Indeed, one reason that we have failed to think rationally about drug laws is that we don’t give any weight to the positive experiences of drug users. When people say that alcohol relaxes them or that marijuana inspires them, we tend to think they are, at best, thinking wishfully or, at worst, in denial. When people claim benefits like enjoyment or even enlightenment from LSD or MDMA, we write them off as dirty hippies.
Though my own heroin and cocaine addiction certainly wound up being more painful than pleasurable, there were plenty of times, especially early on, when those drugs gave me relief, euphoria, a sense of social connection and energy that I cannot deny. When it worked, heroin gave me what I now find to be a primary benefit of antidepressants—not euphoria or a “high,” but simply a feeling of wellness, instead of constant dread. The use of all these drugs persists outside of addiction because people do find the experience valuable.
Consequently, cost-benefit analysis should include pleasure in proportion to the percentage of people who are addicted to a drug—the higher the rate of addiction, the less pleasure should count. That’s because addiction actually robs people of pleasure: There is little fun about using when you know you are hurting yourself and/or those around you, but can’t manage to stop. While there may be some pleasure and relief in avoiding withdrawal and craving, it doesn’t outweigh the harm—otherwise, you wouldn’t be addicted, you’d be rationally choosing to take drugs.
Because different substances produce different rates of addiction, rational drug laws would adjust for pleasure in considering their regulation in a way that would take this into account.
An appropriate accounting, then, would mean that cigarettes’ pleasure should be given very little weight: 60% of smokers smoke daily, for example, meaning that they are both physically dependent on nicotine and qualify as being addicted to it. The comparable figure for marijuana smoking is just 17%—and even here, not all of these users qualify as addicted (some are medical users, for example, and others do not have the compulsive behavior despite negative consequences that would define them as addicted, just as many daily drinkers are not alcoholics).
Because different substances produce different rates of addiction, rational drug laws would adjust for pleasure in considering their regulation in a way that would take this into account. And because different substances produce differing amounts and types of benefits, these, too, need to be considered—all, of course, in light of their risks and harms.
Drug laws for too long have only weighed risks—seeing only addiction, health problems and crime while failing to account for why people who are not addicted risk addiction in order to take them and failing to quantify the harm done by prohibition itself.
If we analyzed sports this way, we would outlaw them, too: There’s far better data showing that football can produce irreversible brain damage, for example, than there is for marijuana. But few people call for outlawing football because we see team sports as a valuable pursuit that teaches things like teamwork, persistence and courage.
Drugs, in contrast, are not valued because the pleasure they bring is seen as unearned: The culture that has sprung up around illicit drugs is viewed as entirely detrimental; its positive facets—like accepting the weird kids who don’t fit into other social groups—are almost never mentioned. Indeed, saying anything positive about drugs is virtually a taboo in the US and Europe: In Britain, for example, when a drug reform group tried to run an anti-stigma campaign with the tagline “Nice people take drugs,” the ads were banned from appearing on public transit.
Factoring drug-related pleasure into a cost-benefit analysis of laws and regulations, then, could be a positive step. Its results, however, might produce outcomes that make us deeply uncomfortable—like having to face the profound irrationality of current drug laws.
Maia Szalavitz is one of the nation’s leading neuroscience and addiction journalists, and a columnist at Substance.com. She has contributed to Time, the New York Times, Scientific American Mind, the Washington Post and many other publications. She has also published five books, including Help at Any Cost: How the Troubled-Teen Industry Cons Parents and Hurts Kids (Riverhead, 2006), and is currently finishing her sixth, Unbroken Brain, which examines why seeing addiction as a developmental or learning disorder can help us better understand, prevent and treat it. Her last column for Substance.com was about how the stigma surrounding both mental illness and addiction may have played a role in actor Robin Williams’ suicide.
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