Unbroken Brain: A Revolutionary New Way of Understanding Addiction

by Maia Szalavitz

This is why “overthinking” can interfere with athletic or artistic performance. Once you know what you’re doing, your expertise lies not primarily in conscious consideration, but rather in what yo...

Emotions, in fact, are probably best described, as the neuroscientist Antonio Damasio pointed out, as decision-making algorithms honed by eons of evolution. The emotions we feel now are the ones that prompted our ancestors to make the decisions that increased their odds of survival and reproduction. From fear and pain to love and desire, our feelings were built to guide our actions, and they incorporate the results of experience over time.

These emotional algorithms, of course, are largely unconscious. But like much about the brain, they require experience for development, and those that help us make good choices about risk need training.

One fascinating study in which adolescents were asked to consider whether such absurd and dangerous acts were a good idea found that it took teens a full sixth of a second longer to say no than it did adults. That seems like a tiny amount of time, but it is long in terms of much that goes on in the brain. And in that sixth of a second lies a world of experience, one that no one has been able to induce faster than it takes teens to actually grow up—if they survive their inevitable bad choices.

the same kind of process is the essence of addiction. Drug taking starts as a rational, conscious choice and through repetition becomes an automatic, unconsciously motivated behavior. Addicted people, unfortunately, seem to offload their ongoing choices about taking drugs to the now “expert” systems that handle unthinking actions, just as musicians no longer have to think about the mechanics of producing the notes they want to play.

One economic theory of addiction, in fact, suggests that the condition can be explained almost completely by the variance in values placed on present and future between addicts and others. Originally proposed by psychiatrist and behavioral economist George Ainslie, this theory suggests that addictive behavior occurs when people repeatedly choose pleasure now without worrying about future pain. And it’s certainly true that addicted people do consistently overvalue current pleasures—and that they do so while continually underrating those that could be better in the future if gratification were delayed.

Ainslie’s theory also nicely accounts for why poverty, chaos, and trauma would increase addiction risk. In such situations, it is actually rational to be tightly focused on the present, because your own experience suggests that a positive future may never come.

If the world is unpredictable and people are unreliable, an available reward now is more valuable ...

In these cases, children who eat the one marshmallow in front of them rather than waiting for two later are actually making the right choice, given the environmental constraints they typically face. One study, for instance, found that when children were given the option to have one treat now or two treats later by either experimenters who had previously kept their promises or those who had not,...

Being present focused and prioritizing whatever good experience you can actually get right now is certainly part of what can lead to addiction—but it can also be an effe...

This makes the question of addiction and choice profoundly vexed. To me, a good analogy for the way will is hampered—but not eliminated entirely—is as follows: Consider a prisoner who is locked in a cell that contains a completely hidden trapdoor to an escape route. On the surface, there is no way out: the bars are strong and placed tightly together, the walls are stone, and the door is securely locked. The window is out of reach, and too small and barred, besides. If the prisoner does not know that the possibility of escape exists via the trapdoor, she is not “free” to choose it—even though another prisoner who does have that information can easily liberate himself. By analogy, while addicted, there are alternative behaviors available to you—and you sometimes even recognize that they do exist—but you simply can’t enact them or believe with enough conviction that they will genuinely help to power yourself through the necessary changes.

This situation is maddening to people who love someone with addiction: you watch them destroying themselves in ways that seem unimaginably selfish and stupid, but despite all efforts, they don’t stop and often can’t see the hurt that they cause.

parenting, even more than coupling, requires the core addictive feature of compulsive behavior despite negative consequences. Virtually all parents who are honest with themselves have had moments when they regret having had children—and studies of people’s daily levels of happiness find that parents actually have less of it than nonparents. This includes lower marital satisfaction, reduced overall life contentment, and less of an overall sense of mental well-being. Surprisingly, these reductions in quality of life are not only seen during the toughest times when children are at their neediest; studies find it to be true throughout the adult lifespan of parents.

Either something is missing in our measures of happiness (which is quite possible) or children often don’t bring the pleasure that they seem to promise.

To be sure, it’s also abundantly true that children bring many times of pure joy. As my own mother once noted, you rarely laugh more or hear more laughter than when you spend your days with small children. But just like in addiction, these good times in parentin...

OF COURSE, TO those who see addiction as the lowest of immoral behavior and parenting as an ideal of selflessness, comparing the two is outright offensive.

Exploring the learning involved in parenting offers yet more insight on the learning processes of addiction and their compulsive nature.

In new love, early parenting, depression, and OCD, serotonin activity seems to be reduced. And that probably occurs because basically, some degree of obsession is normal and healthy in sustaining critical relationships, like those of couples and those between parent and child.

Another crucial aspect of learning in early parenthood, of course, is learning to bond with your particular baby. Contrary to popular belief, parental love is not always “instant” and the capacity for bonding is not destroyed if the baby isn’t immediately placed on the mother’s belly or into the father’s arms.

nothing is actually “instantly addictive” because learning takes actual, not just planned or wanted, repetition.

The fact that addictions can be built on the same system is not an insult to parents or to the meaning of love—but a testament to their strength and power.

addiction is defined by using a drug or activity in a compulsive manner despite negative consequences.

Think about it for a minute: addicted people continue taking drugs despite losing jobs, loved ones, their homes, families, children, dreams, even sometimes body parts.

While there are many experiences that are not common to all addictions, the compulsion to continue using no matter what is its essence.

In this light, the idea that other sorts of threats or painful experiences will stop addiction makes no sense. Addiction is an attempt to manage distress that becomes a learned and nearly automatic program. Adding increased distress doesn’t override this programming; in fact, it tends to engage it even further.

If learning were occurring normally during addiction, addicted people would soon learn not to take drugs because the consequences are so bad. The fact th...

Moreover, a whole series of studies shows that the brain responses of many addicted people to reward and punishment are abnormal, reg...

So why then do so many believe that addiction ends when people “hit bottom” and that criminalizing drug use helps people “bottom out”?

for youth, prison is essentially three times worse than doing nothing at all.

tougher sentences make kids worse.

the adult arrest rates for people who had any contact with the juvenile justice system were seven times higher than for those engaged in a similar level of delinquency who weren’t caught.

the odds of adult crime were more than 37 times higher if the teen was actually locked up in a reform school or juvenile prison. (The researchers controlled for IQ and other obvious factors that might have influenced these results.)

In 2014, the British government assigned experts to look for a relationship between the toughness of a country’s drug policy and the rates of drug use.

But no correlation was found—the same conclusion drawn by a 2008 multinational study published in the peer-reviewed journal PLOS Medicine. In fact, some of the countries with the toughest drug policies have the worst addiction problems.

Why do so many contend that treatment cannot work unless it is backed by punishment, when we know punishment doesn’t work? 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? The answers have more to do with the ongoing racist and moral framing of addiction in drug policy than it does with the effectiveness of incarceration.

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 “enabling” or being loving and kind is counterproductive. Even though these ideas are not supported by evidence, they are frequently used to justify punishment, cruelty, and abuse of people with addictions.

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

To understand the ubiquity of these incorrect ideas, we need to look at their history and how the data actually contradict them.

AA didn’t scientifically test these propositions; its founders were not educated in research methods. To Bill and Dr. Bob, basing AA practices on its members’ experience was valid and sensible. If the two men felt that the “lash” was needed to bring people to the program, that’s how it was.

They called it “raising the bottom.” Maybe in some cases, the reasoning goes, addicts and alcoholics do stop before the disease gets too bad. These people are said to have “high bottoms,” which allow them to see the logic of quitting before they lose that two-car garage.

research finds that legally coerced patients typically do not do better in treatment than those who enter voluntarily, despite staying in treatment longer. There is also significant evidence that empathetic and empowering approaches that let patients set their own goals—basically the opposite of coercion—are far more effective than treatment that relies on confrontation and making people feel powerless.

Another huge problem with the notion of forcing someone to the bottom is that they may not survive it.

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.

AA’s program for dealing with addictions is explicitly moralistic. The steps start with a recognition of one’s “powerlessness” over the addiction and move on to “surrendering” to a “Higher Power” to address the problem. They also include a full confession of all of the sins of addiction (in 12-step terms, a “moral inventory”), attempts to reform one’s “defects of character,” and making amends to people who have been harmed. While 12 steppers (including me at one time; about which, more later) vociferously claim that addiction is a disease, they don’t treat it like one.

“Alcoholics Anonymous is based on love, we are based on hate, hate works better,” Dederich explained. When a heroin addict proclaimed that the organization had solved his drug problem, Synanon began selling itself as a cure for what was then seen as an untreatable affliction.

Only one state—New Jersey—bothered to evaluate Synanon before replicating it, discovering that the vast majority of participants dropped out within a few weeks and only about 15% stayed abstinent. But the data didn’t matter: the media loved Synanon and soon even people without addictions began joining, believing that a life of confrontational, radical honesty among peers would bring enlightenment.

the need to hit bottom can be used to justify disrespectful and abusive tactics in order to prompt someone to feel powerless and desperate enough to try the steps. Since humility is seen as critical to this process, humiliating participants is acceptable. Since pride and confidence are antithetical to surrender, attempts are made to suppress or puncture them. Since social support can aid resistance, people are cut off from access to friends and family and even to kindness from each other during periods of punishment, which often involve being silent and totally shunned. Not surprisingly, this does not empower patients. It is explicitly intended to do the opposite.

In the 1970s, while states across the country like New York and California were creating their own copycat programs, Synanon’s maniacal leader made members stockpile weapons, forced spouses to swap partners, and coerced men to get sterilized and women to have abortions. The only children he wanted in Synanon were those whom the juvenile justice system or parents were paying them to treat; others he saw as a drain on resources. Ultimately, Synanon’s downfall began when Dederich ordered his henchmen to place a derattled rattlesnake in the mailbox of Paul Morantz, a courageous attorney who’d won cases against the group. The snake bit Morantz, who, fortunately, survived. (Dederich eventually did time for conspiracy to commit murder in the case; when arrested, the “ex-alcoholic” who had found a “cure” for addiction was drunk.)

Nonetheless, even today, virtually every publicly funded inpatient addiction program in the United States that calls itself a “therapeutic community” has its roots in Synanon.

As of 1973 there was already evidence that Synanon-style encounter groups could produce lasting psychological damage in 9% of the normal college students who agreed to participate in a study, but nonetheless they continued to be imposed on vulnerable addicted adults and teenagers.