Unbroken Brain: A Revolutionary New Way of Understanding Addiction

by Maia Szalavitz

LEAD is the rare law enforcement program based on harm reduction. The key idea is not to force people into abstinence and punish them if they fail, but rather, to connect them up with services that can help them meet their own goals—like finding a house or a job. By doing so, LEAD cuts arrest and incarceration rates and reduces revolving-door criminal justice costs that typically have had no positive impact on drug use or crime. In Washington State, an average arrest for such low-level crimes leads to a jail term of around three weeks—and the whole arrest, incarceration, and prosecution process typically costs around $3,100 per incident. In contrast, case management for a month by LEAD costs $240.

Over one third of patients treated for substance addictions—including alcohol—have been referred to treatment by the criminal justice system, and in some programs, the proportion is closer to 80% or 90%, according to Kerwin Kaye, a sociologist who has studied drug courts and treatment in New York. This means that many programs come to view the legal system, not their patients, as the customer they serve.

These providers have little incentive to improve care, fire disrespectful staff, provide decent living conditions, and avoid brutal disciplinary tactics, because their patients’ only alternative is incarceration—and because punitive treatment is seen as the most helpful.

the drug court system allows judges to practice medicine without a license—deciding what medications and treatments are acceptable in a way that they never do for other illnesses. No judge, faced with a mentally ill defendant, says that he can take only Haldol but not Risperdal, or that talk therapy must be psychoanalytic, not cognitive.

the more we understand that addiction is a learning disorder and that drug use is often a rational response to an unfair and painful world, the closer we’ll get to good policy.

A prevention program that has been tested in the U.K. and Canada and is currently being trialed in Australia is attempting to answer these kinds of questions. The data so far suggests that, at least in some cases, heavy alcohol and other drug use and the symptoms of mental illness that can drive it can actually be averted. This program takes an explicitly developmental view of all of these conditions, recognizing the critical roles of learning and self-labeling.

“A mental health approach to alcohol and drug prevention looks like it’s much more effective and promising than simple drug education or alcohol education,” Conrod told me.

BY VIEWING ADDICTION as a developmental disorder, we can devise far more effective ways of preventing and treating it. And, by understanding the role of learning in addiction, we can also create better policies to regulate substances to minimize the chances that it will be learned.

By 2014, the World Health Organization had announced that it favors complete decriminalization of all drug use and personal-level possession. And now, no serious drug policy analyst can muster a case for mass arrest and incarceration of users.

To learn addiction, a person must choose to continue using—and such learning through repetitive dosing is most likely if a person is already short of coping skills, extremely stressed and disconnected socially, suffering from childhood trauma, predisposed to mental illness, or otherwise genetically or environmentally vulnerable.

without learning specific, personal cues that drive addictive behavior, addiction cannot occur. Drug exposure isn’t sufficient: a person needs to associate the substance and the trappings of the experience with pleasure, stress relief, or both over and over again in order to get hooked. From Rat Park to Central Park, where, when, with whom, and how you take drugs plays a key role.

Since addiction is learned in specific cultural and physical environments, the “addictiveness” of particular drugs themselves can actually change as societies decide how to manage them.

Punishment Cannot Solve a Problem Defined by Its Resistance to Punishment

All People Learn Better When Treated with Respect

Treatment Must Be Reformed to Be Respectful

Understanding addiction as a learning disorder means creating individualized approaches to address it—on the biological, psychological, social, and cultural levels.

While a reformed system might still refer some people to 12-step meetings for additional support, it would not include professional treatment based on it. There’s no need to pay for what people can get for free—and no need to twist the voluntary steps into a coercive and often harmful approach that encourages abusive behavior by treatment staff in order to create a sense of powerlessness. A better treatment system would also never make referrals to mutual help groups without discussing both the potential risks and benefits—and would always offer alternatives for those who prefer them.

Primary Prevention Should Focus on Coping, Not Drugs

Although the neurodiversity movement calls people who aren’t autistic and don’t have other brain-related diagnoses “neurotypical,” there really is no such thing. Every brain is unique, starting even before birth as the initial wiring is laid down. Our genes don’t contain nearly enough information to direct the placement of every neuron, every glial cell, and every synapse. Many of the first, primitive connections are random, and many useless. Ruthless pruning takes place during development, killing millions of cells that don’t manage to hook up properly or aren’t in networks that represent learning. In the brain, it’s absolutely literally true that if you don’t use particular cells and synapses, you lose them.

there is some intriguing evidence that people in long-term recovery do build up extra gray matter in the prefrontal cortex regions responsible for self-monitoring and self-control.

At least in this case, what doesn’t kill you can make you stronger—and learning to overcome challenges can leave you better off than if you hadn’t faced them in the first place.

We all learn to become who we are. And none of us starts from the same place or encounters the same cultural and social contexts in the same way. Our memories and the way our nervous systems react to them make us unique.

For those of us with addictions or other differences, we need to fight to be recognized not only for our frailties and faults but for what we have to give.