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Addiction is a learning disorder: Why the war on drugs is useless, AA undermines treatment, and addiction studies can learn a lot from autism
Salon talks to Maia Szalavitz on her new book "Unbroken Brain: A Revolutionary New Way of Understanding Addiction"
ZACHARY SIEGEL
April 8th 2016
In September of 1986, Maia Szalavitz was charged with felony possession – nearly 2.5 kilos – of cocaine and faced 15 years to life under New York’s unduly harsh Rockefeller drug laws. Before then, she was a student at Columbia University, but had been suspended for dealing. After getting kicked out of a school she had worked her whole life to get into, her cocaine use accelerated to the point where she was injecting up to 40 times a day, and eventually escalated to speedballs, a powerful mixture of cocaine and heroin in a single shot.
At 23, when the thought crossed her mind of sleeping with a man for drugs, she knew it was time to get help, and voluntarily entered treatment. After her drug charge was eventually dismissed, she built a career dedicated to understanding one of the most complex entanglements human beings endure: addiction. She has since gone on to write about drugs, policy, and science for nearly 30 years with remarkable consistency.
In her impressive new book, “Unbroken Brain: A Revolutionary New Way of Understanding Addiction,” Szalavitz dives into the science of her development, to re-think a condition shrouded in myth and misconception. Her writing is quick and sharp, and takes immediate aim at “a system that calls you ‘dirty’ if you relapse; one that assumes you are a liar, a thief, or worse.” With science, logic, and experience, Szalavitz debunks old, moralistic ideas and replaces them with elegant new ones.
Salon spoke to Szalavitz about how re-thinking addiction can lead to more compassionate treatments and policies that aim to help rather than criminalize people with different wiring. The interview has been edited for clarity and length.
Addiction, in your view, is a neuro-developmental learning disorder. What does that mean?
It means that for one, addiction can’t occur without learning. When I say that, what I mean is literally if you don’t learn that the drug comforts you, makes you feel euphoric or allows you to cope in some way, you cannot be addicted to it—because you cannot crave it, because you don’t know what to pursue despite negative consequences. And that’s important, because people have often thought addiction is just this physiological process that hijacks your brain. That’s really not quite accurate. It involves learning, it involves interacting with the environment, interpreting the environment, and it involves making choices.
The other reason that I think it’s important to see addiction as a developmental disorder is that 90 percent of all addiction occurs between the teens and 20s. That is similar to other developmental conditions such as schizophrenia and depression, which tend to start at that age. That suggests there is a particular period of vulnerability that the brain has and also probably has to do with your life history, as well. When you hit your teens or 20s you’re learning the coping skills you need to handle the adult relationships that are necessary for survival and reproduction. If you are using drugs to escape during this time not only is your brain developmentally vulnerable to not being able to control the use of the drug, but you’re also missing out on developmental experiences that allow you to create other methods of coping.
Your book is scientific and steeped in research, but it is also extremely personal. What was it like researching yourself? Your development?
It was funny because I have done a lot of books that I’ve co-authored with people where I have a similar structure, using their experience to explain certain types of science. I thought, oh, this will be really easy because I don’t have to nag anybody to schedule interviews; I just have to nag myself. It was a lot harder than I thought and I felt a lot more vulnerable than I expected.
Looking back on that stuff was really intense. It sometimes makes me feel old because I look back and think, how the hell could I have done that? And you know at the time it didn’t seem as absurd and messed up as it does to me now. Once you are able to have your cortex exert proper control over your behavior it comes to seem completely alien behaving as an adolescent.
You kicked for good at 23. What’s the significance of that age? What’s going on in the brain developmentally around that time?
That is very interesting, because at that age between, say 23 and 25, is when the final sculpting of the prefrontal cortex is happening. I wondered if I stopped at that age because I had an insight that I needed to stop or because I had the neural ability to carry it out. That’s really not answerable. But at that age it is definitely the case that you are finally developing self-control and greater leverage over the motivational and pleasure areas that can drive you astray.
There is the scene in which you describe having that epiphany, where afterward you voluntarily enter treatment, right around that age.
That’s the way I’ve always framed it. Especially during my 12-step days, it made a good story. I certainly wasn’t being dishonest, that is how I believed it happened. It’s really difficult to determine causality in your own behavior and that’s actually one of the points I’m trying to make in the book. People always ask, “Well, how’d you do it?” And I can only tell you how I think I did it. But I don’t have 20 identical twins that did something different so I can prove this is exactly what happened.
Unfortunately, in the addictions field, we’ve developed this idea that one size fits all, and whatever works for me is going to work for you, and we can extrapolate from my experience to be the experience of all people with addiction. That’s why I like the saying from the autism community, which is: if you met one person with autism you’ve met one person with autism. We should be saying that about addictions. I find it really annoying when people say “all addicts do X or Y.” Well, maybe you do X or Y, but don’t speak for me.
I sort of see you as this addiction myth buster.
A lot of my work has been to try and break down these myths and try to look at more of the complexity without this criminal framing.
Along those lines, the medical establishment frames addiction as a “chronic, relapsing brain disease” and yet the prescription is unscientific, like AA. You argue this bolsters the moralistic and law enforcement approaches. Can you elaborate on how these frameworks are all connected?
Imagine I’m trying to argue that the medical condition I have is a disease. But, everybody who has that medical condition can be locked up for having that medical condition, and, if they’re not locked up, they are sent to treatment that involves prayer and restitution.
So, am I going to believe that’s a disease? If I go to cancer treatment and I get told I’m going to be locked up if my tumor grows or I’m going to have to pray to a higher power and surrender in order to get better, I’m going to definitely think that I’m not in mainstream medicine. I’m definitely going to be thinking that this is not a medical condition, that it’s some kind of sin. The 12-step people don’t see any contradiction in saying addiction is a disease and the treatment is prayer, meeting, and confession. But, from the outside that sounds completely absurd. It does not bolster the disease argument at all.
cont http://www.salon.com/2016/04/07/add...ddiction_studies_can_learn_a_lot_from_autism/
Salon talks to Maia Szalavitz on her new book "Unbroken Brain: A Revolutionary New Way of Understanding Addiction"
ZACHARY SIEGEL
April 8th 2016
In September of 1986, Maia Szalavitz was charged with felony possession – nearly 2.5 kilos – of cocaine and faced 15 years to life under New York’s unduly harsh Rockefeller drug laws. Before then, she was a student at Columbia University, but had been suspended for dealing. After getting kicked out of a school she had worked her whole life to get into, her cocaine use accelerated to the point where she was injecting up to 40 times a day, and eventually escalated to speedballs, a powerful mixture of cocaine and heroin in a single shot.
At 23, when the thought crossed her mind of sleeping with a man for drugs, she knew it was time to get help, and voluntarily entered treatment. After her drug charge was eventually dismissed, she built a career dedicated to understanding one of the most complex entanglements human beings endure: addiction. She has since gone on to write about drugs, policy, and science for nearly 30 years with remarkable consistency.
In her impressive new book, “Unbroken Brain: A Revolutionary New Way of Understanding Addiction,” Szalavitz dives into the science of her development, to re-think a condition shrouded in myth and misconception. Her writing is quick and sharp, and takes immediate aim at “a system that calls you ‘dirty’ if you relapse; one that assumes you are a liar, a thief, or worse.” With science, logic, and experience, Szalavitz debunks old, moralistic ideas and replaces them with elegant new ones.
Salon spoke to Szalavitz about how re-thinking addiction can lead to more compassionate treatments and policies that aim to help rather than criminalize people with different wiring. The interview has been edited for clarity and length.
Addiction, in your view, is a neuro-developmental learning disorder. What does that mean?
It means that for one, addiction can’t occur without learning. When I say that, what I mean is literally if you don’t learn that the drug comforts you, makes you feel euphoric or allows you to cope in some way, you cannot be addicted to it—because you cannot crave it, because you don’t know what to pursue despite negative consequences. And that’s important, because people have often thought addiction is just this physiological process that hijacks your brain. That’s really not quite accurate. It involves learning, it involves interacting with the environment, interpreting the environment, and it involves making choices.
The other reason that I think it’s important to see addiction as a developmental disorder is that 90 percent of all addiction occurs between the teens and 20s. That is similar to other developmental conditions such as schizophrenia and depression, which tend to start at that age. That suggests there is a particular period of vulnerability that the brain has and also probably has to do with your life history, as well. When you hit your teens or 20s you’re learning the coping skills you need to handle the adult relationships that are necessary for survival and reproduction. If you are using drugs to escape during this time not only is your brain developmentally vulnerable to not being able to control the use of the drug, but you’re also missing out on developmental experiences that allow you to create other methods of coping.
Your book is scientific and steeped in research, but it is also extremely personal. What was it like researching yourself? Your development?
It was funny because I have done a lot of books that I’ve co-authored with people where I have a similar structure, using their experience to explain certain types of science. I thought, oh, this will be really easy because I don’t have to nag anybody to schedule interviews; I just have to nag myself. It was a lot harder than I thought and I felt a lot more vulnerable than I expected.
Looking back on that stuff was really intense. It sometimes makes me feel old because I look back and think, how the hell could I have done that? And you know at the time it didn’t seem as absurd and messed up as it does to me now. Once you are able to have your cortex exert proper control over your behavior it comes to seem completely alien behaving as an adolescent.
You kicked for good at 23. What’s the significance of that age? What’s going on in the brain developmentally around that time?
That is very interesting, because at that age between, say 23 and 25, is when the final sculpting of the prefrontal cortex is happening. I wondered if I stopped at that age because I had an insight that I needed to stop or because I had the neural ability to carry it out. That’s really not answerable. But at that age it is definitely the case that you are finally developing self-control and greater leverage over the motivational and pleasure areas that can drive you astray.
There is the scene in which you describe having that epiphany, where afterward you voluntarily enter treatment, right around that age.
That’s the way I’ve always framed it. Especially during my 12-step days, it made a good story. I certainly wasn’t being dishonest, that is how I believed it happened. It’s really difficult to determine causality in your own behavior and that’s actually one of the points I’m trying to make in the book. People always ask, “Well, how’d you do it?” And I can only tell you how I think I did it. But I don’t have 20 identical twins that did something different so I can prove this is exactly what happened.
Unfortunately, in the addictions field, we’ve developed this idea that one size fits all, and whatever works for me is going to work for you, and we can extrapolate from my experience to be the experience of all people with addiction. That’s why I like the saying from the autism community, which is: if you met one person with autism you’ve met one person with autism. We should be saying that about addictions. I find it really annoying when people say “all addicts do X or Y.” Well, maybe you do X or Y, but don’t speak for me.
I sort of see you as this addiction myth buster.
A lot of my work has been to try and break down these myths and try to look at more of the complexity without this criminal framing.
Along those lines, the medical establishment frames addiction as a “chronic, relapsing brain disease” and yet the prescription is unscientific, like AA. You argue this bolsters the moralistic and law enforcement approaches. Can you elaborate on how these frameworks are all connected?
Imagine I’m trying to argue that the medical condition I have is a disease. But, everybody who has that medical condition can be locked up for having that medical condition, and, if they’re not locked up, they are sent to treatment that involves prayer and restitution.
So, am I going to believe that’s a disease? If I go to cancer treatment and I get told I’m going to be locked up if my tumor grows or I’m going to have to pray to a higher power and surrender in order to get better, I’m going to definitely think that I’m not in mainstream medicine. I’m definitely going to be thinking that this is not a medical condition, that it’s some kind of sin. The 12-step people don’t see any contradiction in saying addiction is a disease and the treatment is prayer, meeting, and confession. But, from the outside that sounds completely absurd. It does not bolster the disease argument at all.
cont http://www.salon.com/2016/04/07/add...ddiction_studies_can_learn_a_lot_from_autism/
