Unbroken Brain: A Revolutionary New Way of Understanding Addiction

by Maia Szalavitz

In the context of addiction, the learning that occurs during preadolescence either enhances or diminishes the emotional pain we feel and our sense of either connection or isolation. The more discomfort, distress, trauma, and pain we feel—whether due to overreaction to ordinary experience, underreaction to it, or normal reaction to traumatic experience—the greater the risk.

Although addiction was originally framed by both Alcoholics Anonymous and psychiatry as a form of antisocial personality or “character” disorder, research did not confirm this idea.

If you have come to believe that you yourself or an addicted loved one, by nature of having addiction, has a defective or selfish personality, you have been misled.

As George Koob, the director of the National Institute on Alcohol Abuse and Alcoholism, told me, “What we’re finding is that the addictive personality, if you will, is multifaceted,” says Koob. “It doesn’t really exist as an entity of its own.”

Research finds no universal character traits that are common to all addicted people. Only half have more than one addiction (not including cigarettes)—and many can control their engagement with some addictive substances or activities, but not others.

The whole range of human character can be found among people with addictions, despite the cruel stereotypes that are typically presented.

Unsurprisingly the teens who became frequent users and drinkers had the problems you might expect, like depression, anxiety, and delinquent behavior.

Then again, many of the same psychiatric problems were also seen in the adolescents who rejected the idea of drinking and drugs entirely.

LONGITUDINAL STUDIES LOOKING at addiction risk have found three major pathways to it that involve temperamental traits, all of which can be seen in nascent form in young children. The first, which is more common in males, involves impulsivity, boldness, and a desire for new experience; it can lead to addiction because it makes it hard for people to control their own behavior. The second, which tends to be seen more in women, involves being sad, inhibited, and/or anxious. While these negative emotions can also deter experimentation, when they do not do so, people may find themselves on a “self-medicating” path to addiction, where drugs are used to cope with painful feelings.

All three pathways really involve the same fundamental problem: a difficulty with self-regulation.

In my case, when it came to schoolwork, I didn’t shirk. Indeed, I was desperate to be a good student and terrified of getting in trouble. Here, I had trouble stopping intellectual engagement, not starting it.

In their studies, Shedler and Block found that the abstaining youth were “fastidious, conservative, proud of being ‘objective’ and rational, overly controlled and prone to delay gratification unnecessarily, not liked or accepted by people,” as well as “moralistic,” “not gregarious,” and “basically anxious.”

The relevant areas of the brain include the prefrontal cortex (PFC), which imagines possible futures and plans and makes decisions accordingly. Of particular importance within the PFC is the orbitofrontal cortex, which helps determine the relative emotional and psychological value of your options and, therefore, your level of motivation and your tendency to make particular choices. The PFC works in concert with the nucleus accumbens (NAC), the region famed as the brain’s “pleasure or reward” center. This area is involved in determining the desirability of particular options and how much you want to seek or avoid them. Another region related to reward and motivation, the ventral pallidum, is also part of this brain system, as is the habenula, which seems to be involved primarily in aversion and disliking. The insula, which processes emotions like lust and disgust and also monitors internal states like hunger and thirst, is another node in this circuitry. So is the anterior cingulate, which looks for conflicts and errors and changes emotion accordingly. The anterior cingulate seems to be especially important for obsessive behaviors, perhaps because it creates a sense that things are “not right” until they are perfect or complete. In OCD, it may wrongly detect errors, which could cause constant anxiety. Finally, the amygdala is also in the loop. While best known for its role in processing fear, the almond-shaped amygdala is also involved in a variety of other emotions, includ...

Together, this whole neural network sets values, priorities, and goals. Crucially, parts of it can also simplify repeated behavior into programs for habits that can be engaged or disengaged with little conscious thought.

the genetic heritability of addiction center around 40%–60%, which leaves a large opening for the influence of other factors.

To make it even more complicated, the effects of the environment are subjective, not objective: one person may perceive trauma and rejection where someone else sees minor stress and support, so the interpretation of experience also matters, as does how other people react.

Even just one extreme adversity—like losing a parent or witnessing domestic violence—before age 15 doubles the odds of substance use disorders, according to a study of the entire Swedish population.

you learn that the world is not a safe and stable place—and that others are unreliable—when you are young, it can shape the trajectory of your emotional learning and the way you cope for the rest of your life.

a child with five or more ACEs has a risk of illegal drug addiction 7 to 10 times greater than one who has none;

one study suggested that 64% of risk for these addictions could be attributed to child trauma.

The risk of heavy smoking is nearly tripled for people with five or more ACEs—and alcoholism risk is increased by a facto...

reactions that are adaptive in a stressful world—like rapidly perceiving and responding to even small threats—can also be handicaps in a calmer environment.

Being wired for a future in a threatening world can create a “live fast, die young” mind and body—and this increases addiction risk.

People don’t “catch” OCD by simply washing their hands—and, by the same token, they don’t develop drug addictions by just taking drugs.

Preexisting differences in temperament and in negative experiences are what drives the learning of addiction.

The problem isn’t the existence of activities and substances that offer escape; it’s the need for relief and the learned pattern of seeking it that matters.

banning new ones or cracking down on old ones may make policy makers feel like they are “doing something,” but it ignores the real problem, which is the distress that makes people seek escape. Worse, this penalizes people whose condition itself is marked by failure to change when punished.

research suggests that kids of preschool age often fixate on ideas of “goodness” and “badness” as they relate to themselves and tend to see the world in stark extremes of black and white.

From this research, it is clear that many kids do decide whether they are “good” or “bad” or “smart” or “stupid” at a very young age—and they also form lasting views about whether such traits are permanent or changeable.

Children take in and react to what they are told about themselves, in unpredictable and often unintended ways.

These initial self-concepts shape their choices and, in turn, their brains. If you think you are good, you may act one way, but if you think you a...

Parents and others who influence the way children see themselves are typically quite unaware of the power they have over this—and even the best intentioned cannot do it perfectly, nor can they predict how a particular child will react.

mindset. However, Dweck found one factor that has a large effect: the way that parents and teachers praise them.

Kids who are praised for being, say, smart or athletic or artistic or musical tend to develop a “fixed” view, while those who are rewarded and encouraged for their effort in a particular area learn to see ability and character as something that can grow with experience.

To find out what was causing this defeat response, the researchers looked at self-development in younger children. Around age two, kids normally begin to have a sense of self that they can compare to that of others. This can be seen in the fact that they begin to show a sense of pride when they achieve goals that are applauded by adults and a sense of shame when they don’t live up to grown-ups’ standards. While preschoolers and kindergartners don’t tend to focus much on how their abilities compare to others at this age, they are, as one study puts it, “very concerned about whether their performance means that they are ‘good’ or ‘bad.’”

Unfortunately, little children can’t clearly distinguish between moral goodness and other valued qualities like beauty, intelligence, diligence, tidiness, and physical ability; it’s all wrapped up together for them.

Dweck’s research shows that this confusion can cause problems for children who get the idea that their value as a person depends on their ability to achieve certain goals. It’s these children, her experiments show, who respond with helplessness or despair when a task is too challenging—but only if it is a task in an area they’ve decided matters.

For example, a child who sees herself as an athlete might respond to a setback in sports by feeling ashamed and unworthy, whereas one who has decided that it is his English skills that make him valuable and not his soccer performance would simply shrug off the same experience.

Addictions grow in the interaction between childhood temperament, childhood experience, and children’s interpretation of their experience.

Drugs alone do not “hijack the brain.” Instead, what matters is what people learn—both before and after trying them. While this may seem hard to believe in light of claims that certain drugs are “instantly addictive,” in fact, one of the reasons that addiction is best seen as a learning disorder is that it simply cannot take place if someone doesn’t learn over time to associate a drug with pleasure and/or relief.

Addiction is, first and foremost, a relationship between a person and a substance, not an inevitable pharmacological reaction.

If you haven’t learned that a drug “fixes” you, you cannot be addicted to it, even if your body is dependent on it.

The failure to distinguish between physical dependence and the learning that creates addiction is also why, contrary to claims you may see made in the media, babies can’t actually be “born addicted.”

children of alcoholics have a risk of developing alcoholism that is two to four times greater than that found in the general population, even if they are adopted by nonalcoholics or raised by parents in recovery.

Before I hit my teens, I’d already begun a habit of rumination and self-loathing; research now shows that youth who learn these thinking patterns are more prone to adult depression. When you wear a groove of self-denigration into your brain, your thoughts simply tend to slide into it more often: like a muscle that gets repeated use, the pathway of negative thinking gets stronger. As with any other habit, it then becomes less conscious and more part of the background, like your mental furniture. Rather than something you have constructed, it comes to seem like “the way it is” rather than a potentially warped self-perception. And research suggests that for women especially, this is a classic route to addiction: from depression to drugs.

A recent study published in Child Development explored what happens to the youth who rise to the social peaks by engaging in risky behavior ahead of their peers. These are often the children labeled definitively by their middle-school classmates as “popular”—even though they sometimes turn out not to be the kids with the most friends.

This distinction is important: what kids usually mean by “popular” is what evolutionary psychologists studying primate behavior would label “dominant.”

In other words, while the nicest kids are actually the most popular by the numbers, they are typically not the most dominant.

Emotion powers learning: it marks what’s important for survival and reproduction, which is what matters in biology. (This is also why it’s easier to remember dull material when you associate it with silly sexual innuendo, for example.)

The Whitehall Studies (named after the headquarters of the British state bureaucracy) were led by Sir Michael Marmot, who was knighted as a result of this research. The first wave included some 18,000 men. Marmot and his colleagues found that, contrary to popular ideas about “executive stress” and heart attacks felling the boss, it’s generally far less healthy—and far more stressful—on the bottom. At age 40 to 64, low-ranked clerks were three times more likely to die of any cause compared to those at the top of the heap. The correlations were graded: each step up the ladder lowered risk, each step down raised it. Gradients favoring those with high status were found in heart disease, stroke, diabetes, obesity, addictions, infectious disease, and some cancers.