Drugs Are Fun and That Should Figure Into Our Understanding of Addiction
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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.