Chasing the Scream: The First and Last Days of the War on Drugs

by Johann Hari

Chemical hooks play a real role in addiction—but it’s not most of what’s going on. How do we know that? The evidence is huge, but just to recap some of the highlights I’ve already discussed in the book:

One. The chemical hook in tobacco is nicotine, and it’s widely agreed to be one of the most powerful hooks out there. So when nicotine patches were introduced, there was a huge wave of optimism, because they give smokers all of the chemical hook their body craves, with none of the filthy smoke. How many stopped smoking? 17 percent. It’s a real factor—but doesn’t account for 83 percent of the problem.

Two. In hospitals in Britain, medical patients are often given medically pure heroin as a painkiller (for example, during hip operations). Everyone agrees heroin is more potent than Percocet or Oxycontin. How many people become addicted to this heroin in British hospitals? Virtually none. This shows there has to be something else going ...

Three. When people are trying to come out of opioid addiction, they initially go through a process of detox, where the physical dependence they have built up on the chemical...

Many people relapse into their addiction months or years after detoxing—long after their body’s hunger for the physical hook has passed from their system. Why? Not because of the drug’s lingering physical effect, which is long gone; it is because they find it unbearable to be present in their lives, because ...

Four. Go to any meeting of Gamblers Anonymous, anywhere in the world. They are deeply addicted, as much as any person who obsessively drinks alcohol or injects heroin. But there is no chemical hook buried in a pack of cards or a poker machine.

you can have all of the addiction with none of the chemical hooks. This tells us that we have overstated the role of chemical hooks in addiction, and understated other factors.

Five. One in 130 prescriptions for an opiate such as Oxycontin or Percocet results in addiction, according to the National Survey on Drug Use and Health. (That makes up around 10 to 15 percent of users over ti...

If the chemical hooks alone were the driving factor, we would expect to see those addictions spread evenly throughout the country—as high in Beverley Hills as in the Appalachian Mountains. They are not. The addictions cluster in specific areas, wh...

What changed is the amount of distress in the society. In eighteenth-century England, many people—the ones worst affected by the Gin Craze—had been deprived of the things that made life meaningful to them. They were in terrible psychological pain—and so they turned to the best anesthetics to hand.

there is scientific evidence that there are nine different kinds of disconnection that are making us deeply distressed—and that are, in turn, leading many of us to seek out very powerful anesthetics.

This is why the most detailed scientific exploration of the opioid crisis, by Professors Anne Case and Angus Deaton, described their casualties as “deaths of despair.”

But there is equally strong evidence—as I explain in Lost Connections—that you have natural psychological needs. You need to feel you belong. You need to feel your life has meaning and purpose. You need to feel you have a future that makes sense. Our culture is good at lots of things, but we have been getting less and less good at meeting these deep underlying psychological needs—and this is the key driver of this crisis.

just throwing people off once they have become addicted, which is required by U.S. law as it currently stands, is a disaster.

In Switzerland, if you are addicted to an opiate, the authorities do two things. They prescribe the opioid you’re addicted to, for as long as you feel you need it. And, at the same time, they give you a huge amount of love and practical support, to deal with the reasons you are in such distress. They get you decent housing, and a job, and extensive therapy.

there is overwhelming evidence that depression, anxiety, and addiction are responses to deep social forces that are rising around us.

For example: the less control you have over your work, the more likely you are to despair.

our brains change as a result of how we live our lives.

Cacioppo says we need to think in terms of “social neuroscience”—your brain is reshaped by social forces.

you can’t find a simple, symbolic solution to a social and spiritual crisis.

The drug war, and the addiction crisis, are symptoms of a deeply disconnected culture, and we need to begin the long and difficult work of healing that culture.

it is only by connecting with others in a spirit of love that we can find our way out of a crisis built on disconnection and despair.

Courage calls to courage everywhere.