Unbroken Brain: A Revolutionary New Way of Understanding Addiction

by Maia Szalavitz

In both autism and addictions, for example, repetitive coping behaviors are frequently misinterpreted as the source of the problem, rather than being seen as attempts at solutions.

Addiction is far less common in people who use drugs for the first time after age 25, and it often remits with or without treatment among people in their mid-20s, just as the brain becomes fully adult. In fact, 90% of all substance addictions start in adolescence, and most illegal drug addictions end by age 30.

addiction is the psychiatric disorder with the highest odds of recovery,

As B. F. Skinner himself observed, “A person who has been punished is not less inclined to behave in a given way; at best, he learns how to avoid punishment.”

Heroin was the only thing that really worked, the only thing that stopped him scampering around in a hamster’s wheel of unanswerable questions. Heroin was the cavalry … [it] landed purring at the base of his skull, and wrapped itself darkly around his nervous system, like a black cat curling up on its favourite cushion. —EDWARD ST. AUBYN, BAD NEWS

An effective dose of methadone varies from patient to patient but is typically over 60 milligrams (I was given 30) and ultimately reduces craving for heroin without producing euphoria. At such a dose, methadone also blocks your high if you relapse. I never experienced that.

with at least one third of all methadone programs still failing to provide an adequate dose.

studies find that psychological breakthroughs are not the typical path to change and rarely lead directly or in any linear way to alterations in behavior.

Indeed, research suggests that having an intention to do something only predicts engaging in the desired behavior about 33% of the time, even for people without drug problems.

William Miller has labeled “quantum change,” in which a minority of people do suddenly completely shift course—as opposed to the more typical gradual process of fits and starts.

those who exchange sex for drugs or engage in prostitution to support their habits: if harm occurs, they themselves are the most likely victims and many women who do this have lengthy histories of childhood sexual abuse.

I have absolutely no pleasure in the stimulants in which I sometimes so madly indulge. It has not been in the pursuit of pleasure that I have periled life and reputation and reason. It has been the desperate attempt to escape from torturing memories, from a sense of insupportable loneliness and a dread of some strange impending doom. —EDGAR ALLAN POE

Like music, language, art, and tool use, the pursuit of altered states of consciousness is a human universal.

It is a rare human who has never taken a drug to alter her mood; statistically, it is non-users who are abnormal.

Though drug education programs tend to avoid publicizing these statistics, the expert consensus is that serious addiction only affects a minority of those who try even the most highly addictive drugs, and even among this group, recovery without treatment is the rule rather than the exception.

the word addiction referred to a social relationship of bondage: its Latin root means “enslaved by” or “bound to.”

The first American state laws against cocaine, for example, were passed in the South in the depths of the Jim Crow era.

According to historian David Musto, “The fear of the cocainized black coincided with the peak of lynchings, legal segregation and voting laws all designed to remove political and social power from him.”

said plainly that the main reason to ban cannabis was “its effect on the degenerate races.”

He claimed that “reefer makes darkies think they’re as good as white men” and warned, “[t]here are 100,000 total marijuana smokers in the U.S., and most are Negroes, Hispanics, Filipinos and entertainers. Their Satanic music, jazz and swing result from marijuana use. This marijuana causes white women to seek sexual relations with Negroes, entertainers and any others.”

1936’s Reefer Madness—may seem laughable now it helped create the dru...

Some insurers estimated that alcoholism rates rose by 300% as Prohibition continued. Meanwhile, the murder rate went from 6.5 per 100,000 in 1918 before Prohibition to 9.7 per 100,000 in 1933, the year of repeal, nearly a 50% rise. Suggesting that the relationship was likely to be causal, this rate then fell back under 6 per 100,000 by 1942.

research suggests as many as 10,000—were killed by government attempts to keep people from drinking alcohol

in 1926, the Coolidge administration began ordering manufacturers to add poisons like methyl alcohol, gasoline, chloroform, carbolic acid, and acetone to industrial alcohol in an attempt to prevent it from being diverted to bootleggers.

legs ached terribly and I banged them against the bed in a vain effort to knock the pain out. This common response is probably why they call heroin withdrawal “kicking.”

It’s the mental and emotional symptoms—the learned connection between drugs and relief and between lack of drugs and pain—that matter.

In fact, it’s this type of existential terror and anxiety that actually gives the most excruciating flourish to any bad experience: the meaning of pain profoundly affects how it is felt, and the more worry and fear involved, the worse the suffering.

Pain that is viewed as life threatening literally feels more intense and agonizing than pain with a known, nondangerous origin or time frame; studies find that people who believe a particular type of pain means that worse is to come actually rate it as more severe on pain scales than they do if they have t...

whether the source of pain is obviously “physical” or “just psychological,” the unpleasant aspect of the experience is processed by many of the same parts of the brain. Not coincidentally, these regions are rich in opioid receptors.

Since most addicts tend to use as much as they can at any given time, this means that they will swing from periods of being high to those of withdrawal,

Even if the occasions when the drug produces euphoria become less common, they still do occur, providing intermittent reinforcement.

In contrast, if you provide a steady, pure, stable supply, tolerance will predominate: the more steady and regular the dosing is, the more tolerance will build. Very rapidly, an opioid user on maintenance will no longer experience a high because he or she will be on a stable plateau of tolerance.

if the person is stabilized on a high enough methadone dose, even if they try to take additional opioids...

The end result is that on a dose that could kill a user with no tolerance, stable maintenance patients can work, drive, and be otherwise unimpaired, simply because their dose is no...

Tolerance also means that maintenance does not block emotional growth or automatically make people distant in relationships. In order to use opioids to escape emotion, you need to get “high,” and s...

Unfortunately, because people don’t understand these basic facts about the role of timing and dosing in addiction, maintenance patients are stigmatized as being constantly “high” and “not really in recover...

Importantly, the learned relationships between a regular time and place and the use of a drug is also someti...

Tolerance in general is generated by routine. Taking the same dose of the same drug in the same place maximizes tolerance by strongly linking the experience of being in that specific situation to ...

As a result, when routine changes, so ...

For decades, in fact, users and physicians have reported cases where people take the same dose of the same drug that they have previously used uneventfully, but suddenly, mysteriously overdose on it. Often, it later turns out that these folks took the drug in a new environment or social setting, not as part of their typical habit. Sometimes, a new source of stress is involved—for example, a lost job or breakup. In these cases, the unconscious cues that normally activate tolerance don’t do so—and without tolerance, the normal dose becomes an overdose. It seems that sometimes, context alone can change a safe dose to a lethal dose. And this effec...

Stimulants, because of their direct effects on dopamine, seem to produce far more severe sensitization of wanting and diminution of liking; opioids, because they act on opioid receptors that directly mediate liking, create a less extreme dissociation between the two. And this is why “stimulant maintenance” treatment like using Ritalin to treat cocaine or methamphetamine addiction does not seem to be as successful as opioid maintenance. It is much harder to create tolerance with a drug that imitates the pleasures of desire than it is with one that simulates the experience of satisfaction. While these drugs may be useful to treat people whose addiction is linked to untreated ADHD, so far the data are not as promising as for opioid maintenance.

Contrary to the claims of those who criticize opioid maintenance as “just replacing vodka with gin,” the difference is that opioids produce complete tolerance in steady-state dosing, while alcohol does not.

During the experiment, the researchers offered both groups of rats access to morphine-spiked water, which was sweetened enough to overcome the bitter taste that would normally make rats avoid such a beverage. They also had access to plain water. But while the caged rats lapped up the morphine draught, the Rat Park residents mainly refused. Under some conditions, the caged rats took 19 times more morphine than the rats that had companions and space to explore. Even when all of the rats were made physically dependent on morphine and taught that drinking it could relieve withdrawal symptoms, the Rat Park rats resisted it. The caged rats drank eight times more morphine than the Rat Park rodents in this part of the experiment.

This is why, no matter how many times the media panics over a new drug that’s “more addictive than heroin” where “one hit gets you hooked for life,” the vast majority of people who use it don’t become addicted.

People with decent jobs, strong relationships, and good mental health rarely give that all up for intoxicating drugs; instead, drugs are powerful primarily when the rest of your life is broken.

And many other studies have since found that social contact and enriched environments have major effects on animal drug use.

For example, allowing mother rats access to their babies reduces cocaine use (showing that even in rats, the drug doesn’t abolish maternal instincts, as some have claimed about crack). Male prairie voles (a type of field mice) that have established a monogamous relationship take less amphetamine, a phenomenon also seen in human males who are married. And providing a running wheel reduces cocaine use by 22% in male rats and a whopping 71% in females.

rats take half as much time to learn to self-administer cocaine if they have first been beaten in a fight by a more dominant rat than they do if they haven’t been previously defeated. They also take much more cocaine if given the opportunity to binge after losing fights.

Addictiveness is incredibly dependent on context: in some situations, rats clearly do prefer cocaine to food, otherwise those early experiments in which some starved themselves to death by binging on cocaine would never have worked or been replicated.

tautological