Unbroken Brain: A Revolutionary New Way of Understanding Addiction

by Maia Szalavitz

In 2001 through 2005, the prevalence of DSM-defined illegal drug abuse or dependence was 10.3%, suggesting that our trillion-dollar law enforcement spending spree may have actually increased addiction rates—or at any rate, didn’t decrease them.

How can advocates claim that addiction is a disease like any other—and then contend that criminal sanctions are required as part of treatment, which is not true for any other disease?

while the adolescent brain may have some adaptive properties, its way of handling risk is not one of them in the modern world, and heavy drug use and addiction certainly exacerbate this.

“rock bottom.” This concept is at the root of our public justifications for using punishment to fight addiction.

Without understanding the insidious effects of this idea, it will be difficult to move toward treating addiction as the learning disorder it is.

Conventional wisdom has it that people with addictions must “hit bottom” before they can recover—and that harsh and humiliating treatment facilitates this process, while “enablin...

Even though these ideas are not supported by evidence, they are frequently used to justify punishment, cruelty, and...

These notions originated in 12-step programs, which are now a required curriculum in at least 80% of America...

Twelve-step language like “enabling” and “bottoming out” has entered the vernacular, and the idea that addiction is a “disease” of “powerless...

AA didn’t scientifically test these propositions; its founders were not educated in research methods.

By 2000, 90% of all addiction treatment was 12 step based (the number has since contracted, but not much).

The growth of 12-step programs and related rehabs and the publicity they received over the years made the idea that addicts need to hit bottom before they can recover into conventional wisdom.

research finds that legally coerced patients typically do not do better in treatment than those who enter voluntarily, despite staying in treatment longer.

“Force is the best medicine,” one drug court official told sociologist Rebecca Tiger, who has extensively studied these connections.

The idea of “bottom” justifies both punitive coercion to force people into treatment and punitive forms of treatment themselves. But it is based on erroneous reasoning.

For one, the definition of “bottom” is extremely subjective. There’s no way to tell who can recover with only a high bottom and who “needs” b...

Second, “hitting bottom” can only be defined retrospectively after a period of recovery. If the person has relapsed, by definition, they haven’t really hit bottom since they are not in recovery anymore. Now, they wil...

With at least 90% of addicts relapsing at least once, the only way you can really know for sure if someone’s bottom is the true one...

What this means is that every major relapse becomes a new bottom. And that makes a mockery of the idea that there is a clear lowest-ever turning point and th...

Research shows that some people bounce back easily after a relapse; others get worse than they were before; others enter a static cycle of recovery and relapses, getting nei...

But the reality is that “bottom” is a narrative device in a story of sin and redemption, not a medical description of a key stage in recovery from addictions.

Worse, the evidence on what makes for successful recovery actually contradicts the “bottom” story: people are actually more likely to recover when they still have jobs, family, and greater ties to mainstream society, not less.

the more “social capital” someone has—friends, education, employment, job contacts, and other knowledge that promotes links to the conventi...

AA’s program for dealing with addictions is explicitly moralistic.

While 12 steppers

vociferously claim that addiction is a disease, they don’t treat it like one.

Imagine a psychiatrist telling a depressed person to surrender to God and take a moral inventory—or better yet, imagine this being prop...

For no other medical condition is such treatment acceptable in mainstream medicine—

AA explicitly states that its steps are “suggested” and emphasizes that its program is voluntary. But when supporters founded treatment programs, that concept was abandoned.

Even now, any residential treatment center in the United States that lasts a minimum of three months (typically eighteen) and calls itself a “therapeutic community” owes its start to Synanon, and many counselors remain convinced that the tough approach to getting people to hit bottom is justified.

While the 12-step approach is relatively benign when chosen, it can be devastatingly harmful when coercion enters the picture.

Since pride and confidence are antithetical to surrender, attempts are made to suppress or puncture them.

And of course, as in the rest of health care, trying to force people to feel powerless, humiliated, and as though they are at the lowest possible point in their life is a recipe for harm, not help.

There are few better ways to make people feel powerless than locking them up and controlling every aspect of their lives. There’s no conflict between viewing addiction as a disease and as a crime if you believe punishment is the cure for the disease.

Of course, as we’ve seen, the data don’t support this.

PTSD actually increases relapse risk in addicts—and having PTSD doubles to quadruples the risk of becoming addicted in the first place.

a thorough review of the data on humiliation, punishment, and confrontation as treatment for addiction shows that it is not helpful, leading to worsening addictions and greater numbers of treatment dropouts.

Although the Minnesota Model emphasizes that addiction is a brain disease, what it really does at its best is teach ways to manage the aberrant learning at the heart of the problem.

A review that rated the most and least effective tactics ranked movies and talks at number 48 of 48, that is, essentially useless.

Indeed, most people who do not age out of teen misbehavior didn’t really “age in” to it in the first place—they had problems that started long before they hit puberty, which simply continued or worsened.

Addiction is not a personality disorder; as noted earlier, there is no single set of personality traits seen in all people with addictions.

Among addicted people, however, that figure is indeed much higher—with 18% of those who have some type of illegal drug use disorder also affected by ASPD and 9% of those with alcoholism affected. This proportion is higher in men (20%) than women (14%) and may be as high as 37% in IV opioid users, particularly men.

borderline personality disorder—only 16% of people with alcohol or other drug addictions have this condition.

Machiavellianism,

depressive: I spoke rapidly with what might have appeared to be a symptom known as “pressured speech,” and it was obvious from my frequent crying and occasional elation that my moods were unstable. But all of that can also occur during withdrawal

research suggests that creating a coherent narrative out of your experience may help recovery from trauma,

myself, from knowing me. It crystallized ways of seeing myself that were distorted and wrong. Then, it anesthetized me so I didn’t have to examine them, and it kept me from developing better means of coping.

The talks that highlighted this sort of asceticism were the kind of teaching that every student hates—didactic and focused on what the teacher thinks is important, not on what the students really want to know and can use.

Since these apparent experts told me both that addiction was a medical disease and that the treatment was meetings, confession, and prayer, I didn’t notice the contradiction that is now obvious to me when stating these facts.

I learned that if I could just stop hating myself for hating myself, I didn’t feel quite so bad.