Silly Studies on Addiction
Silly Studies on Addiction
Some of the sharpest, most uncomfortable insights into human nature have come from psychological studies: Stanley Milgram’s legendary Yale study showed that we are willing to inflict intense pain on strangers in obedience to an authority figure. Philip Brickman’s studies of happiness in paraplegics and lottery winners showed that six months after a life-changing event, people's happiness level was still dependent on small, ordinary pleasures. Daniel Simon's and Christopher Chabris’ Harvard study using basketballs and a gorilla suit showed that people often fail to register seemingly remarkable phenomena right in front of them.
Something about the word “study”—especially when combined with a prestigious university (Harvard, Yale, Stanford), a long governmental name (The United States Preventive Task Force Panel), or an impressive acronym (SAMHSA)—seems to turn off our brain's skeptical switch. (This is worth a study of its own.) Every day the media touts one or another "promising," even "breakthrough," study, almost inevitably confirming our faith that science is always making progress—treating and curing diseases, for example.
Aa critical second look at many of these studies reveals that there is far less to their conclusions than we might think. They are not scientific. They may have no objective experimental protocols, no control groups, a too small or too unrepresentative sample size (a common failing of Big Pharma drug tests to get positive results). They seem to have been dreamed up by researchers late at night, and the fact that they ever got funded in the light of day seems preposterous.
A critical second look at these studies reveals they are silly or shoddy or duh! or hype or biased or some combination thereof.
Harvard University holds the annual "Ig Nobel Prizes" to "honor" the year's most ridiculous research. In 2011 the Prize in Physiology went to a research paper called "No Evidence of Contagious Yawning in the Red-Footed Tortoise." The Prize in Medicine went to a study that concluded that people's decision making is influence by their need to urinate. The Prize in Biology went to a study of why beetles like to mate with a particular brand of bumpy Australian beer bottle. The Prize in Mathematics was shared by an unlikely group of doomsday predictors, from Christian Right televangelist Pat Robertson to New Age guru Elizabeth Clare. All of them falsely "announced" the imminent end of the world—proving that successful predictions require mathematical modeling rather than…whatever.
Even Princeton 2002 Nobel Prizewinner (Economics Science) Daniel Kahneman recently went after scientific studies in general and those in psychology in particular. "Your field is now the poster child for doubts about the integrity of psychological research,” he wrote in an open email to researchers who work on “social priming”—studies in which subjects react to cures. “I believe that you should collectively do something about this mess."
Lately a lot of this mess has focused on addiction. A recent study (US Preventive Task Force Panel, with 16 experts!), for instance, suggested that doctors should ask their patients whether they drink too much. Well, duh! “How often do you have a drink containing alcohol?” primary physicians are advised to ask patients. And: “How often do you have five or more drinks on one occasion?” Of course ask any alcoholic and he or she will tell you that one of the main symptoms of alcoholism is lying to your doctor. Nonetheless, one of the 16 experts suggested that questioning by doctors might keep people who drink too much from becoming alcoholics. If only!
The annual SAMHSA (Substance Abuse and Mental Health Services Administration) study released this month showed the same lack of common sense. The results were hyped as showing modestly positive trends: Underage drinking is down; binge drinking in college is about the same; fewer young people are taking prescription drugs. But a closer look at SAMHSA’s numbers shows that the data was gathered by asking the students themselves about their pattern of booze and pill consumption. Really? How many 18-year-olds would admit to a government researcher that he or she spent the weekend hammered or popped Adderall or Oxycontin scored from a campus dealer?
Science still cannot tell us which treatment program works better: abstinence vs. harm reduction vs. nothing at all.
Another widely reported study was the Colgate University Study presented last month at the Annual Meeting of the American Psychological Association. This study concluded that binge drinkers drink in order to raise their social status. “Students who are considered socially powerful [white males] drink more,” said the study’s co-author. “Binge drinking then becomes associated with high status”—and the rest of the student body aiming to "improve" their reputation follows suit. But this sweeping conclusion about "college binging" was based on interviews with students at only one college—an unnamed liberal arts institution in New England. What makes the SAMHSA researchers confident that their results can be generalized to very different colleges, such as party paradise Ohio University, Catholic college Notre Dame or even the Mormons' Brigham Young?
These studies are often amusing, but the situation isn’t funny. At the same time that too many academic and federal researchers are investing precious resources on silly studies, the nation's epidemic of addiction is in urgent need of serious studies. In the US, where only a tiny fraction of research budgets are spent on mental health care by private industry, academia and the government, the statistics we have about the who, what, where, when and why of problem substance use are little more than guesswork. No one really knows.
And forget about the effectiveness of treatment programs. Even after decades, science still cannot tell us which works better: abstinence vs. harm reduction vs. nothing at all. It's still anyone’s guess. Another chronically unsolved but fundamental mystery: What is the best way to identify alcoholism or drug addiction? There are many answers, none definitive.
Almost all other diseases—physical or mental—have the hard data that enable patients and their families to make the hard decisions about treatment (benefits vs. costs). Where is the famous Framingham heart study—5,000 people carefully monitored over more than 50 years—for addiction? Until we get serious about the way we study addiction issues, many people—and their families/caretakers—will suffer needlessly.
Susan Cheever, a regular columnist for The Fix, is the author of many books, including the memoirs Home Before Dark and Note Found in a Bottle, and the biography My Name Is Bill: Bill Wilson—His Life and the Creation of Alcoholics Anonymous.