By Katharine Gammon
In courtrooms around the country, judges are embracing 24/7 Sobriety, a science-backed approach to managing people addicted to alcohol who repeatedly drive drunk. Every morning and evening, defendants and convicts in the program must take a Breathalyzer test at a local police station. If they’re sober, they get an immediate reward: freedom. If not, they’re arrested on the spot and jailed overnight.
“It’s a modest penalty,” explains Keith Humphreys, a Stanford professor of psychiatry and behavioral sciences who helped popularize the program. “But unlike anything else, this is swift and certain, and that is perfect for a person who is addicted.”
The prospect of future rewards and punishments doesn’t much influence people whose brains have been changed by addiction. “We all have trouble thinking about the future,” says Humphreys. “We all spend money on our latte when we should be putting it into retirement.” But in addicted people, that human truth is vastly amplified. The 24/7 approach is about working with brains as they are, “thinking about the people who are addicted, who have reduced [self-] control and are very present-oriented.”
Humphreys didn’t start out interested in neuroscience. For two decades, he worked on public policy solutions to addiction. Then in 2015, Humphreys joined forces with two other Stanford professors, Robert Malenka and Brian Knutson, to create the NeuroChoice Initiative, an interdisciplinary collaboration among more than a dozen faculty members spanning departments from psychiatry and neurobiology to law and economics to electrical engineering. Their ultimate aim: to build a robust picture of how humans make choices, for their own good and to their detriment.
Their work, and the work of others at Stanford, is moving addiction science out of the lab and into society in the form of better diagnostics and treatment. Decoding the brain’s reward system also enables businesses to help—or harm—people tipping into compulsive behaviors, and it can help lawmakers create evidence-backed policies that better protect public health.