Unbroken Brain: A Revolutionary New Way of Understanding Addiction

by Maia Szalavitz

All of this is why, when substances are involved, the pattern of use can be every bit as important as the drug’s pharmacology—and why brain changes linked to simply taking a drug don’t create a “disease” of addiction.

As behavioral addictions prove, these brain changes can occur even without drugs. And with drugs, they don’t occur automatically. The pattern of use, the users’ prior history and brain ...

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 effect can even be seen in rats: if they are made tolerant to a high dose in one place and then given the same dose in a new environment, 50% will actually die of overdose.

Alcohol, incidentally, also does not work for maintenance. Unlike opioid tolerance, alcohol tolerance doesn’t completely eliminate impairment, even if the drug is given in steady, regular doses. That means that even with high levels of tolerance, heavy alcohol users on a consistent dose are still significantly impaired. 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.

When given options, rats, like humans, tend not to slip into addictions. 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.

By itself, nothing is addictive; drugs can only be addictive in the context of set, setting, dose, dosing pattern, and numerous other personal, biological, and cultural variables.

Addiction isn’t just taking drugs. It is a pattern of learned behavior. It only develops when vulnerable people interact with potentially addictive experiences at the wrong time, in the wrong places, and in the wrong pattern for them.

It is a learning disorder because this combination of factors intersects to produce harmful and destructive beh...

In both love and addiction, the stress relief system has become wired to the object of the addiction—you need the drug or the person to feel at ease, in the same way that young children need their parents.

our understanding of how humans bond chemically began with research on the sex lives of two types of obscure field mice. One kind, the prairie vole, belongs to the select five percent of mammal species that are monogamous, meaning that they form long-term sexual and child-rearing bonds with members of the opposite sex (though, as in humans, this bonding doesn’t rule out sexual infidelity). Another type, known as the montane vole, hooks up but never settles down. Montane voles mate promiscuously and the males don’t parent. When Carter and her colleagues realized that the key difference between these animals was their mating patterns, they recognized that studying their brains could potentially reveal how monogamy is represented anatomically. And after the researchers peeked inside the voles’ brains, these anatomical distinctions became clear. The two species’ dopamine systems are wired quite differently. In female prairie voles, the pleasure and desire circuitry contain large numbers of receptors for a hormone called oxytocin. In male prairie voles, this circuitry has many receptors for both oxytocin and another hormone called vasopressin. But in montane voles, it’s another story. Both male and female montane voles have far fewer of these respective receptors in the relevant regions.

As Carter and her colleagues discovered, oxytocin is critical to the social lives of mammals. “It’s taking over parts of the nervous system and putting information into them about a sense of safety and trust,” she told me. Without oxytocin, mice cannot tell friends or family from strangers—and mothers do not learn to nurture their young.

Also, the particular distribution of oxytocin and vasopressin receptors in the pleasure systems of prairie vole...

Montane voles, in contrast, are not wired for monogamy. Sex feels good to them, of course, but the particular partner doesn’t matter. Montane voles don’t have enough receptors for oxytocin or vasopressin in their pleasure regions—so they never link the memory of a specific mate with the joy of sex. For a montane vole, any attractive member of the opposite sex will do. Only sexual novelty, not familiarity, brings pleasure in this species.

studies show that differences in genes for oxytocin and vasopressin receptors play a role in the way people handle relationships and in conditions that affect social skills, like autism.

For example, some research suggests that a variation in the vasopressin receptor gene in men—similar, but not identical to, the one that affects monogamy in male voles—is associated with a 50% reduction in the likelihood of marriage and poorer quality marital relationships in those who do marry.

oxytocin has become known as the “love hormone” or “cuddle chemical.”

Oxytocin apparently teaches us who is friendly or at least familiar—and who is not. Chemically, it seems to help wire the memories of our loved ones into the programming of our pleasure centers. Unfortunately, oxytocin can apparently also do the same for the memory of drugs.

In drug addictions, rather than associating a person with stress relief and pleasure, those connections are made with the drug.

Intriguingly, in fact, a few small studies suggest that oxytocin may relieve withdrawal symptoms in heroin and alcohol addictions—perhaps as a result of this wir...

while oxytocin strengthens bonds and encourages altruism among “us,” it also elevates hostility toward “them,” with studies showing that it can increase racism or other types of discrimination based on who we see as part of our in-group and who we see as outsiders. Oxytocin makes social signals stronger and more memorable, but it doesn’t necessarily make them feel good.

“wanting” is more linked to dopamine, while opioids seem to be involved in both wanting and liking.

Preferences formed in childhood do affect romantic predilections in animals and humans as well. For example, adult male rats who were stimulated with a paintbrush to simulate maternal licking while exposed to a lemon scent during infancy ejaculate more quickly (presumably meaning that they are more excited) when paired with similarly scented females. Childhood play with peers also affects sexual arousal later—female rats that played with either almond- or lemon-scented female playmates as pups later preferred to mate with males with the familiar scent, rather than the unfamiliar one. The specifics of how oxytocin and other chemicals vary when making sexual, parental, and other social bonds are not known, though clearly these bonds are not identical.

Both chemistry and environment play a role in how you learn to love and who you learn to love.

In essence, oxytocin teaches you what to expect from a partner. If your parents are warm and reliable, you learn to expect that in romantic relationships. On the other hand, if you learn that affection is barbed, you may find it hard to recognize love in a healthier context; in fact, you may gravitate toward brutal or uncaring partners.

You may also compulsively seek drugs because you discover that they provide a sense of being truly loved that you can’t find elsewhere. If your bonding systems are miswired for any reason—genetic, environmental, or both—you also may not be able to feel the love other people actually do have for you and may also look for relief in drugs.

Like love, addiction is learned in light of a particular developmental context; your childhood affects your risk for addiction in part because of how it affects the way you experience love.

This means that each addiction is as individual and particular as each love, making the experience of addiction and the road to recovery immensely variable.

Moreover, to love, you typically have to persist despite negative consequences—as Shakespeare put it, the course of true love never did run smooth. It is a rare relationship that never requires compromise or perseverance. Love really...

The idea of codependency itself—that some people are overly dependent on their partners and try to escape their own issues by trying to solve other people’s problems—is relatively uncontroversial.

But the codependency movement stretched this idea to dangerous extremes. Because addiction was defined as a disease, codependency became one as well. No one, however, was ever able to come up with a diagnostic tool that reliably distinguished between “codependents” and those without the disorder. Moreover, the problem of codependency was soon combined with the idea of “tough love,” which diagnosed nearly any caring behavior toward people with addiction as “enabling” their drug use to continue.

As a result, codependency counselors and Al-Anon members recommended withholding love and material support. Add this to an individualistic culture where any type of dependence on others is seen as weakness and you have a recipe for pathologizing normal human needs while

Because it was rooted in 12-step programs, the codependency movement was also deeply committed to the idea that addiction is a disease. And if addiction was an illness, then sick codependent love had to be a medical disorder, too. The role of learning and culture and how they interact with biology and psychology was ignored.

“It is a sad irony for us that our work contributed to labeling of yet more ‘diseases’ over which people are ‘powerless,’” Peele and Brodsky wrote in a 1991 preface to an edition of Love and Addiction, printed when codependency was all the rage. While they had wanted to show that normal love could go awry in a compulsive and life-contracting way—just as drug use can—instead, their work was interpreted to mean that all relationships were mere addictions and most love was delusional and self-centered.

Back then, any relationships an addicted person had were presumptively labeled “codependent”—even if the person was in recovery. The idea that a person with an addiction could be genuinely loved for herself was mocked.

Although research rapidly showed that there is actually no way to scientifically distinguish between people with “codependence” and everyone else, the idea continued to spread and is still taken seriously by a distressingly large percentage of professionals in the addictions field today.

There is no “codependent” personality, no “brain disease” of codependence, no predictable course of any such “disorder.” A “diagnosis” of codependence is about as scientific as a horoscope—

love is real when it expands and enhances your life—and troubling and problematic when it contracts or impairs it.

Whether you love a person, a drug, or an intellectual interest, if it is spurring creativity, connection, and kindness, it’s not an addiction—but if it’s making you isolated, dull, and mean, it is.

calling the official diagnosis for addiction “substance dependence,” which was the label for the condition in the editions of the DSM published during codependency’s heyday, subtly implies the same thing. “Dependence” itself is pathologized, when, as we’ve seen, dependence isn’t the real problem in addiction: compulsive and destructive behavior is. (And indeed, the DSM-5, published in 2013, recognizes this, replacing “dependence” with “moderate to severe substance use disorder.”)

Healthy relationships are essential to recovery: while love isn’t always all you need, without it, few people get better. Love can’t always cure addiction—but lack of it or inability to perceive it often helps cause addiction.

Compassion is part of the cure, not the disease. Our societal belief that toughness is what works instead is a huge part of why our drug policy is so disastrously inept and harmful.

determining which relationships are healthy and which aren’t, what qualifies as too much passionate involvement and what is appropriate, and figuring out whether someone is enhancing rather than diminishing your life isn’t always easy. Human...

The exact same type and level of drug use may be healthy for one person in one place at one time—and unhealthy for another or even for the same person in a different situation.

Part of the function of emotions themselves is to carve important experiences into memory, so learning love or addiction is visceral. These experiences aren’t just stored like other memories; the changes are deeper, longer lasting, and more pronounced. That’s is why it’s a lot easier to remember your first love than it is to remember the specific material you were taught in school the year you met him. Love and addiction change who we are and what we value—not just what we know.

CORNELL’S VALERIE REYNA studies how young people’s risk decisions can go awry—and her conclusions are counterintuitive. Her research suggests that the major reason that teens and young adults are unreasonable about risk is not that they are too emotional when they consider it—but rather, that they are too rational.

there are two important factors. First, young people do tend to weigh immediate benefits more heavily: the visible prospect of pleasure literally looms larger in their minds than anything else that might happen later.

Second, adolescents get lost in deliberation when they do consider negative consequences—and being out in the weeds doesn’t tend to spur good judgment.

Interestingly, this isn’t a problem limited to teens and risk decisions; it’s a difficulty seen with any type of inexperience or lack of expertise. If you haven’t encountered a similar probl...

That’s because of the way the brain learns to process information. When you first learn any process, you have to consider what you do carefully, think through every step deliberately, and monitor yourself closely. But once you become experienced—whether with dancing, decision m...

Your brain ultimately calculates the “gist” of the data or behavior and offloads its processing to less conscious and, ironic...