Newsline, A Publication of the College on Problems of Drug Dependence, Volume 13, Number 3, May 2009
Discovering Addiction: The Science and Politics of Substance Abuse Research
By Nancy D. Campbell
The University of Michigan Press, 2007, 301pp.
Review by Jack E. Henningfield
The Johns Hopkins University School of Medicine and Pinney Associates
“Discovering Addiction” is an insider’s story of the Lexington Narcotic Farm, later named the Addiction Research Center (ARC). The sources include more than 60 interviews and innumerable published and archival documents including meeting minutes and personal accounts of drug addiction researchers. Many of the researchers are past and present CPDD members. This is a great story, but also a first rate documentary written by a historian, Nancy, D. Campbell, Ph.D., who is Associate Professor in the Department of Science and Technology Studies of Rensselaer Polytechnic Institute. She has written a fascinating account of the emergence and evolution of the ARC. It is also implicitly an account of the emergence and early evolution of CPDD because the history of the ARC is inextricably intertwined with the history and even many organizational aspects of CPDD. In turn, this is a history of the evolution of the concept of addiction itself. It is a must-read for CPDD members because it is our history. CPDD members will find reading it much as though they had suddenly discovered an insightful history of their own family history with lots of eye-opening details and personal insights that help explain the hows and the whys of today.
Many may be surprised at how many links they have with the ARC through mentors and colleagues. Just as nearly all roads in behavioral pharmacology lead to Joe Brady, so do many roads in addiction related science lead to the ARC. Discovering the intricate intertwining, and sometimes clashing, relationships in the field are engaging and make the book hard to set aside. The numerous and often colorful quotes of pioneers past and present give this book warmth, reality, and relevance to where we have come from, where we are, and insights on where we are going as a field, and for CPDD, as a scientific organization.
Long-term members who have lived through changes in name and affiliation of the College from its early days as the Committee on Drug Addiction (CDAN from1928-1965) and Committee on Problems of Drug Dependence (from 1966 to 1990) will appreciate reading this account of history of which they were a part. Newer members are sure to be fascinated by the many challenges, scientific, ethical, and political, that needed to be surmounted to “discover” the scientific foundation for addiction. Many will be surprised by how much of the College’s current activities and standing committees go back decades to the core initial goals of the College. These included the search for nonaddicting analgesics, assessing the abuse potential of novel chemical entities, and developing methods for scientifically valid and ethical human and animal research – activities that to this day remain challenges for CPDD researchers and are exemplified by presentations at the annual meeting of the College.
Nancy Campbell developed this book over 5 years of research during which she investigated the history of our field through the literature, through archival digging, reviews of various historical records and personal histories and her own recorded interviews, many of which are posted at the University of Michigan Substance Abuse Research Center Website (see:http://sitemaker.umich.edu/substance.abuse.history/oral_history_interviews).
She uncovered a treasure-trove of facts, pictures, videos, and insights, including a 1964 photographic archive of the Michigan primate laboratory and the Addiction Research Center taken by former Life Magazine photographer, Bill Eppridge. Many CPDD members have already seen some of these works at the Robert Wood Johnson Foundation, Innovators Awards Program Addiction Art galleries at CPDD, and several are presented in “Discovering Addiction”. As a scientist who has done some work with nicotine, I love the shot of a Michigan laboratory technician smoking a cigarette with a monkey perched on his back.
One of the several stories running through the book was the challenge of determining which human populations would provide the most valid and generalizeable data in experiments that would be considered ethical – at least at the time. More than half a century ago, as today, these questions were as important as the scientific hypotheses that such research was intended to resolve. Then, as today, there were differences of opinion as to what populations could be tested and under what conditions, and then as today, research leaders clearly took the bioethical questions as seriously as the scientific questions. Wikler, Isbell and other ARC researchers felt that well experienced former drug abusers were the only population that could ethically be given many of the drugs under the conditions necessary to explore their addictive effects. On the other hand, Beecher, at the Harvard Anesthesiology Laboratory, known as the “father of informed consent”, felt that people with addiction histories would yield atypical responses of little generality to the larger population.
Clinical researchers of today will surely appreciate the bioethical travails of these pioneers who were trying to do the best research and do it right, but without guidance such as flowed from the Belmont Report on the Protection of Human Research Subject, or from today’s Institutional Review Boards. Nonetheless, Discovering Addiction gave me a heightened appreciation for the degree to which their research approaches embodied the three key principles of the Belmont Report, namely, respect for persons, beneficence, and justice. Nonetheless, when science, bioethics and political aspirations collided in the 1970s, political aspirations won, and the Addiction Research Center’s clinical research program at Lexington ground quickly to a halt. Fortunately, it reemerged on the Johns Hopkins Bayview Campus in Baltimore where researchers learned to safely and ethically conduct valid research with a non-prisoner population.
Nancy Campbell uses the words of Himmelsbach, Wikler and many others to show the reader how scales came to be developed to measure withdrawal, and the time course of drug effects. We learn how the hallmark construct of addictive drug effects, “euphoria,” was as controversial then as now for what it was, how to measure it, and what findings about euphoria meant. We see controversies that remain today over the importance of personality and individuality versus environmental conditions in the development of addiction. As new technology-enabled research approaches emerge from molecular genetics and cerebral imaging, the phenomena of the human experience associated with the reinforcing effects of drugs and addiction remains among the most challenging to capture and quantify. I suspect that Isbell, Wikler, Himmelsbach, Frazier, and the many other pioneers of the ARC would tell us not to forget to spend time observing and communicating with drug users to keep in perspective the phenomena that we hope that research will be increasingly able to explain, to be more creative in our approaches to measure such experience, and in turn to determine which measures provide the greatest generality and predictability beyond the laboratory.
This issue includes a review of Nancy Campbell’s book “Discovering Addiction: The Science and Politics of Substance Abuse Research”. The book was suggested by Jack Henningfield, who graciously agreed to review it. The timing of his submission was fortuitous, as Nancy Campbell will be awarded the CPDD/NIDA Media Award this year. She will be recognized for her body of work in the addiction area, including her books “Using Women: Gender, Drug Policy, and Social Justice”, “Discovering Addiction” and for her contributions to the “The Narcotic Farm”, as well as numerous articles and presentations. Hopefully, the review will encourage CPDD members to read “Discovering Addiction” as well as her other books.