Unbroken Brain: A Revolutionary New Way of Understanding Addiction

by Maia Szalavitz

“don’t compare your insides to someone else’s outsides,” meaning that most people try to present the best parts of themselves, but you can’t hide your negative aspects from yourself.

Although research shows that whether a counselor has his or her own addiction history does not affect outcomes, some contact with people who have been there and recovered often matters.

The data are clear that social support aids both mental and physical health—and that people with more of it are much more likely to recover.

Social support is the single most important factor in mitigating severe stress and trauma, which often contribute to addictions.

We all tend to learn best when we feel safe and curious and want to connect and win our teachers’ respect.

just hearing others admit their anxieties, fears, and hopes inevitably helps ground you.

HALT, which stands for “Don’t get too Hungry, Angry, Lonely, or Tired,”

I’d often discover that a “drug craving” was actually hunger, irritation, or a need for sleep or social contact, which I could manage without resorting to heroin.

As Nietzsche put it, “He who has a why to live for can bear almost any how.”

I realized that I’d always felt subhuman because the standards I had for myself were superhuman.

I had exacerbated the problem by being hard on myself for being hard on myself, creating a recursive loop of metadistress.

SO HOW CAN we reconcile the moral and medical? Is addiction, like light, inherently dual—not either a wave or a particle, but alternately a sin or a disorder, depending on context?

A critical part of why addiction treatment fares so poorly in contrast to general medicine is that it has not been held to a standard that requires scientific proof. It isn’t even held to the Hippocratic oath of ensuring first and foremost that no harm is done.

A 2006 Cochrane Review—the highest level of medical evidence, often used by countries with national health plans to determine what treatments should be covered—summarized the data plainly: “No experimental studies unequivocally demonstrated the effectiveness of AA or [Twelve Step Facilitation],” the authors concluded.

two thirds of Americans support employment discrimination against people with addictions, compared to just 25% who think discriminating against people with other mental illnesses is okay.

the 12-step idea of powerlessness is disempowering.

Research shows that the more someone believes in the idea that addiction is a disease over which he is powerless, the worse and more frequent a person’s relapses tend to be.

predators are overrepresented in the program both because of the elevated prevalence of antisocial personality disorder among the addicted and because sex offenders are often court mandated to attend.

It is not true in addiction care that “doing something” is always better than doing nothing: bad or inappropriate treatment can demonstrably make things worse.

addiction affects the brain’s valuation systems in much the same way that overwhelming thirst or starvation does.

“psychological” as completely distinct. Despite all of this, however, we do not address the moral outcomes of any other medical, psychiatric, or learning disorder by making patients engage in confession and restitution.

In conjunction with symptoms of many medical and psychiatric conditions, people often become irritable, inconsiderate, selfish, dishonest, or even violent, but treatment does not include confession, prayer, or amends. In

Just as no one would trust a brain surgeon whose only training was having had a brain tumor removed, we shouldn’t think that simply having recovered from addiction makes someone an expert.

Further, regardless of the fact that the idea of a Higher Power can be made acceptable to some atheists, every U.S. court decision made on this question has found that mandatory AA violates the separation of church and state.

Teaching practices like surrendering to God and taking moral inventory in rehab not only wastes time and money, but it also reinforces stigma and undercuts the idea that addiction is a medical problem—specifically, a developmental disorder.

Facing a felony charge is a major life stress, which has been compared to losing a close friend or facing a life-threatening illness.

Talk about powerlessness: in court, it seemed as though I were in a foreign country and barely able to speak the language, helpless to do anything but watch as my entire future was debated in ways I couldn’t understand or affect.

studies show that whites use drugs at the same rates as African Americans and actually sell

These days, the lifetime odds of going to prison for a black man in America are 1 in 3—a figure that has doubled since Richard Nixon declared war on drugs in the 1970s.

Between 1980 and 2011, the annual number of drug arrests of black men rose 164%, while arrests for property crime and violent crime fell: homicide arrests fell by 46%, robbery arrests by 27%, and burglary by 42%.

We are now the world’s largest jailer, with 5% of the world’s population, but 25% of its prisoners.

Rates of heroin addiction in people making less than $20,000 per year are triple those for people who earn $50,000 or more.

It owes its name to a 1987 article published in a British newsletter by Russell Newcombe, which was headlined “High Time for Harm Reduction.” In his article, Newcombe argued that policy makers must accept that drug use is ineradicable and focus instead on minimizing damage associated with it.

Opioid overdose risk is not static; it’s linked with fluctuating tolerance—

I had yet to realize that too much suffering can be even more life-constricting than addiction: being trapped alone in bed in emotional or physical pain can be as bad or worse than being trapped alone in a room shooting up.

Indeed, people on the right dose of a maintenance drug—whether an antidepressant or an opioid—aren’t “numbed out”; they are at the right level of sensitivity to allow optimal emotional functioning for them.

Since people start out tuned differently, where they start will affect what they need to get to the right place. If your baseline is too far above normal, you will need a different remedy than if your baseline is far below it.

The action of a drug depends not just on its pharmacology but on the person’s baseline. If you are starting out way too high on a dimension—even a seemingly good one like sensitivity—going lower may be helpful.

The wide range of responses to antidepressants probably has to do with the huge variety of natural human wiring, which can make the same drug into a poison, a panacea, or a placebo, depending on the dose, the timing, and the patient.

What matters is what works best for each individual. And what works best will depend on a complex interaction between a person’s biology and what they have learned.

addiction is driven by learning—not just exposure to a particular substance, having certain genetic traits, or being traumatized.

Dependence on a substance, person, or experience to function isn’t its essence—a learned compulsion that continues despite punishment is what matters.

People learn best in environments where they feel connected to others—not places dominated by a sense of threat and fear.

Harm reduction

“meets people where they’re at,” and it teaches them how to improve their lives, whether or not t...

Alan Marlatt put it, “Harm reduction does not try to remove a person’s primary coping mechanisms...

Instead, it allows people to learn new skills and then move away from drugs, rather than attempting to...

Make one drug illegal and another, more dangerous one will take its place. —MIKE POWER, DRUGS 2.0: THE WEB REVOLUTION THAT’S CHANGING HOW THE WORLD GETS HIGH

Pharmacology, dose, use patterns, use locations, drug prices, and cultural beliefs all influence the development of addiction. None of these can be controlled through outright prohibition. But they can all be shaped by regulated markets.

In 2014, researchers at Stanford demonstrated that it’s possible to produce opioid drugs like morphine using a genetically modified form of baker’s yeast;