A New Way to Understand Addiction

Author and reporter Maia Szalavitz says America is long overdue for new thinking on addiction, "both because our understanding of the neuroscience underlying addiction has changed and because so many existing treatments simply don’t work.” Our friends at Juvenile Justice Information Exchange sat down with Szalavitz to discuss her new book on the topic, Unbroken Brain: A Revolutionary New Way of Understanding Addiction. The following has been edited for length.

'Unbroken Brain'

'Unbroken Brain'

How does your work differ from some of the other work out there?

There’s traditionally been two different ways of seeing addiction. Either it’s a sin and you’re a horrible bad person and you are just choosing to be hedonist or it’s a chronic progressive disease. And while I certainly believe addiction is a medical problem that should be dealt with by the health system, the way we’ve conceptualized addiction as a disease is not actually accurate, and it has unfortunately become stigmatizing and it’s also created a lot of hopelessness in a lot of people.

… Addiction is when you fall in love with a drug instead of a child or a lover and the learning that takes part in that part of the brain is designed by evolution to get us to persist despite negative consequences to do what we need to do — because I don’t know anybody who could survive a relationship or parenting if not for the ability to persist despite negative consequences. The problem is when that gets misdirected to a drug and then you can find yourself in some very negative and potentially deadly situations.

… a lot of addiction actually ends by age 30 — something like 50 percent of all addictions with the exception of tobacco — and I think a lot of what’s going on there is that the self-control areas of the brain are finally developed enough to be able to stop yourself from relapsing or just continuing. There is a maturational aspect to it as well.

You’ve said addiction is misdirected love — how can that misdirection be redirected?

Punishment by definition isn’t going to help. So what you need to do is to help people to change and recover is to help them find different areas of passion and help them find better ways of coping. Because about 50 percent of people with addiction have a preexisting mental illness, about two-thirds have had some type of severe trauma during childhood, and they are not using to the point where they’re risking their lives because it’s fun. They’re doing something to help them cope.

And so in order for people to recover, we can’t just say ‘love is all we need.’ Love is great and it does help a lot of people, but a lot of people do have things like depression or schizophrenia or bipolar disorder or other disorders, all of which will need to be addressed in order for people to stay in long-term recovery.

And so because addiction is a developmental problem, the developmental stage is important, things like employment are important, things like having a sense of purpose, meaning and hope are important, and this is why there’s been so many spiritual cures for addiction, because those things often give people a sense of meaning and purpose. The problem is that we have a first amendment in the country and you can’t impose — or you shouldn’t be able to impose a spiritual solution on people and it doesn’t work. You’re either amenable to that or you’re not, and so this makes it a very complicated problem.

What implications does that have for incarceration?

Punishment is not going to fix it. We should not be putting kids in cages and hoping that is going to fix their psychological problems of any type. Incarceration is as useful for addiction as it is for diabetes — i.e., not useful and potentially harmful, particularly for kids.

… People have just created these irrational ideas that um, well, we just need people to suffer the most extreme consequences and then they’ll get better and this whole idea of hitting bottom is not the answer. It’s a great spiritual story of sin and redemption, but it’s not a medical scientific thing.

So what works? What can parents and other concerned adults do about drug use?

If you’re worried about a kid and drug use, the safest, best thing to do is individual counseling or family therapy, none of which will expose kids to more deviant or problematic peers and both of which are proven to be effective and at the very least, they won’t hurt. In a criminal justice setting, it’s very hard to create a therapeutic environment where people do feel safe, but the real important thing to do is to do your best to do that. Because the best outcomes that are seen for therapy intervention and for other psychological interventions is where the therapist really connects and the person really feels understood. That matters often even more than the technique.

What about legalization?

We absolutely should legalize marijuana. Marijuana is not not harmful, but is the least harmful psychoactive substance that we have, with the possible exception of caffeine.

… I don’t think there’s a single child who’s ever benefitted from being arrested for marijuana or for underage drinking; this does not solve the problem. It makes worse problems because a) it puts them into the system, and b) it gives them a potential criminal record to have to deal with and it can have consequences for school.

The thing we want for all our kids is that they be connected with a learning community and that they have strong social and familial relationships. If we can do whatever we can do to create that and to reduce bullying and to reduce the kind of pain and shame so many kids feel for so many reasons, that stuff is going to reduce addiction. It may not necessarily reduce use. But again, 70 percent of my generation used and we created Steve Jobs and Obama and Gore. We have to stop panicking over this stuff.

What about our current drug laws?

The thing about our drug laws is that they’re not based on science. Science could never get you to make alcohol and tobacco legal and marijuana illegal. Only racism can do that. And that’s what we have. We have a system that was devised by racists to create racist ends.

And I know that sounds really extreme, but if you just look at the history, you will find Harry Anslinger [first U.S. commissioner of the Bureau of Narcotics] going on about satanic swing and how reefer will make black people think they’re as good as white people — which to him, obviously, was a very horrible outcome. This is the basis of our drug laws. 

... Do we really want to base our 21^st-century policy on what the colonialist preferred at a certain time in history, not at all based on health or what the preferences of different cultures might be? That’s just ridiculous. I think our drug laws need to be made scientifically, as best as possible, recognizing that values will always be part of that.

Beyond the science, how did your background help form your views?

I don’t have kids, but I’ve often noticed when people first become parents they seem to completely forget their own adolescence and they start to, as their kids become teenagers, try to do the things that didn’t stop them themselves. And I jokingly frame this as: Your brain gets wiped of those memories when you become a parent.

I also had my own addiction to cocaine and heroin in my 20s. I knew that it was driven not by the things that the drug workers were telling me; in fact, I couldn’t believe any drug information that was given to me by authorities because I knew from my own experience that it was wrong. ... And the reason I ended up taking those risks, I eventually learned, was not because I was some horrible creature that is evil and bad and wrong, but because I was wired slightly differently and I found that these substances allowed me to connect socially, allowed me to feel OK and not overwhelmed by my sensory issues and emotional dysregulation, so having had that personal experience, I knew that a lot of the stuff that we say about these things is just wrong.

I think having the personal experience made me understand a lot more — that’s not to say I can speak for everybody with addiction, I think there’s a huge range of experiences.

Read the full story at Youth Today.