Maia Szalavitz (2016, June 25) “Can You Get Over an Addiction?” The New York Times (http://nyti.ms/28V0oZA, accessed 21July16)
Addiction is a complex and controversial issue, with responses ranging from a “War on Drugs” and criminalization of drug users and dealers to viewing addiction as a disease—or even a learning disorder. The first end of the spectrum tends toward punishment of drug abusers (more likely among the poor of color) while the latter suggests empathy, compassion and relearning.
Szalavitz has experienced heavy drug use and relearned life free from drugs, has studied the matter, and then written a book, Unbroken Brain: A Revolutionary New Way of Understanding Addiction (2016), St. Martin’s Press, 352pp)—as well as this article.
In describing her own experience, Szalavitz sees herself born and growing up with
… a hyperactive nervous system that constantly made (me) feel overwhelmed, alienated and unlovable… finding a substance that eases social stress becomes a blessed escape. For me, heroin provided a sense of comfort, safety and love that I couldn’t get from other people…. Once I’d experienced the relief heroin gave me, I felt as though I couldn’t survive without it.
I shot heroin and cocaine while attending Columbia in the 1980s, sometimes injecting myself many times a day and leaving scars that are still visible. I kept using, even after I was suspended from school, after I overdosed, and even after I was arrested for dealing, despite knowing that this could reduce my chances of staying out of prison.
My parents were devastated: They couldn’t understand what had happened to their “gifted” child who had always excelled academically. They kept hoping that I would somehow stop, even though every time I tried to quit, I relapsed within months.
Szalavitz stopped taking drugs for good when she was 23 and went on to graduate from Brooklyn College cum laude. Focusing on science, addiction and public policy, she has been a successful author, journalist and activist since then. From her experience and subsequent studies, she suggests two theories for her addiction:
(that) simply I was a selfish criminal with little regard for others… (or)
that my brain had been chemically “hijacked” by drugs, leaving me no control over a chronic, progressive disease.
The facts of neuroscience presented by Szalavitz are known to many; her application of these facts breaks new ground to most.
Addiction is indeed a brain problem, but it’s not a degenerative pathology like Alzheimer’s disease or cancer, nor is it evidence of a criminal mind.
Instead it’s a learning disorder, a difference in the wiring of the brain that affects the way we process information about motivation, reward and punishment. As with many learning disorders, addictive behavior is shaped by genetic and environmental influences over the course of development.
Without going into details, the writer has given us clues as to her own genetic and environmental situation leading her to find needed “comfort, safety and love” in a disordered but logical release from staggering loneliness and social stress.
Szalavitz goes on to analyze the neuroscience leading to a learning disorder which selects chemical solace over real life rewards and assurances. Reminding us of scientific studies “documenting the connection between learning processes and addiction,” she describes the specific regions of the brain now known to be affected:
… studies show that addiction alters the interactions between midbrain regions like the ventral tegmentum and the nucleus accumbens, which are involved with motivation and pleasure, and parts of the prefrontal cortex that mediate decisions and help set priorities.
It is this reordering of real-life priorities that constitutes the description of addiction as a learning disorder. Drug dependency restricts the user to certain aspects of the lower rungs of Maslow’s hierarchy of needs. Avoidance of pain and some promise of pleasure and sense of belonging become overwhelming necessities for those whose motivational patterns have been neurally altered.
The learning perspective also explains why the compulsion for alcohol or drugs can be so strong and why people with addiction continue even when the damage far outweighs the pleasure… and why they can appear to be acting irrationally. If you believe something is essential to your survival, your priorities won’t make sense to others. (The addicted person) has just learned a maladaptive way of coping.
The author’s analysis also suggests that the part of the brain affected in addiction is the region that motivates human beings toward love and reproduction. If this is so, getting over addiction may be like getting over a broken heart—rather than facing a life threatening disease. “Healing a broken heart is difficult and often involves relapses into obsessive behavior, but it’s not brain damage.”
Szalavitz’s position rejects any punitive approach to the addicted. “If addiction is like misguided love, then compassion is a far better approach than punishment…. We need more love, not more pain.” She also stresses maturation over any kind of moralizing.
Her position is skeptical of the well-known and popular Twelve Step Program, which she sees as helping “only a minority of addicted people.”
Even today, most treatment available in rehab facilities involves instruction in prayer, surrender to a higher power, confession and restitution prescribed by the steps. We treat no other medical condition with such moralizing—people with other learning disorders aren’t pushed to apologize for their past behavior, nor are those affected by schizophrenia or depression.
Maia Szalavitz’s conclusion is that “addiction is neither a sin nor a progressive disease, just a different brain wiring….” On this basis she is suggesting effective responses and treatment.
Questions for Reflection and Discussion
- Frankly, what situation or interest brings you to this article? What have you hoped to get from it—and from other articles here on addiction?
- What most positively impresses and encourages you from this article? Or, do you react more negatively to Szalavitz’s analysis and suggestions?
- Can it be that AA’s notable successes, besides explicit faith healings of addictions, and Szalavitz’s approach of “relearning” without moral or faith recourse, are not an “either…or,” but a “both…and” in dealing with this complex problem, in a confusing culture, among complicated and unique individuals?
- How do you think we can create the best public policy to deal with the costly and painful issue of addiction? What initial steps would you suggest? Where do you want to go from here?
- First of all, we suggest a hearing of many stories. Maia Szalavitz’s story is one story worth hearing and considering. There are many other stories of persons struggling with loneliness, insecurity, and depression that we must hear. We must listen carefully to the addicted, and certainly the varied stories of those who have come out of serious abuse of chemical substances must be considered. Furthermore, stories from those who work with addicted people, many of them who have come out of addiction themselves, should be carefully considered.
- To the stories must be added reputable scientific studies. We should be grateful for the great advances in neuroscience and brain imaging.
- If recovery from a destructive dependence on alcohol, drugs or any chemical substance is important, and if such recovery is considered release from a faulty learning pattern, then critical attention to a new learning pattern is essential. When negative dependence and an empty life are rejected, new sources of comfort, safety, belonging and accomplishments are most important. Moving from chemically restricted lives to lives that are full, must be individual, communal, and societal goals.
- If our reading, reflection and discussion don’t lead to new, effective public policy, then our efforts are mostly in vain.
Dean Borgman© 2019 CYS