Apr 18

“Unbroken Brain”: Addiction Is Learned

…(A)ddiction is a developmental disorder—a problem involving timing and learning, more similar to autism, attention deficit hyperactivity disorder (ADHD), and dyslexia than it is to mumps or cancer. Maia Svalavitz, Unbroken Brain

According to journalist Maia Svalavitz‘s new book Unbroken Brain: A Revolutionary New Way of Understanding Addiction, the ages-old wisdom about addiction recovery is often off base.

Some of the ideas Svalavitz sees as myths:

  • The addict has a “broken brain.”
  • An individual becomes addicted because of his or her “addictive personality.”
  • One type of addiction treatment fits all individuals.

Or as Dana Goldstein, Slate, eloquently points out on behalf of Svalavitz, the entire following scenario is suspect:

The narrative of addiction is familiar. A pleasure-seeking ‘addictive personality’ spirals out of control, ‘enabled’ by friends and family, and eventually hits ‘rock bottom’ in the form of arrest, divorce, or homelessness. She may then succeed in a 12-step program, where she’ll embrace a ‘higher power,’ receive ‘tough love,’ and accept total ‘abstinence’ from substances including antidepressants and drugs that ease withdrawal symptoms. Even if she gets clean, she’ll be an addict forever, and is more likely than not to relapse.

In long-term recovery herself (cocaine and heroin), Szalavitz “offers an alternate way of thinking about what addiction is: neither an illness nor a sign of an immoral personality, but a learning disorder.”

How does she define addiction? “Compulsive behavior despite negative consequences.” Why/how does this happen? The addict learns “that the problematic substance can help soothe some other problem in [one’s] life, such as depression, social anxiety, physical pain, or, in Szalavitz’s case, what she believes was an undiagnosed childhood autism-spectrum disorder.”

What This Means For Addiction Treatment

A few basic principles addressed in Unbroken Brain:

  • Individuals can benefit significantly before hitting rock bottom.
  • Not all substance abusers have to forego all substances. The harm reduction model can work well for many.
  • Imprisonment usually doesn’t benefit the addict and often makes things worse.

Moreover, 12-step programs are only useful for some. Publishers Weekly: “Szalavitz may alienate otherwise sympathetic readers with her critiques of popular treatment methodologies such as 12-step programs. This study may not be for people who have recovered using such treatments, but it can help promote the importance of understanding—and working toward fixing—a persistent problem.”

Marc Lewis, author of The Biology of Desire“Szalavitz catalogs the latest scientific knowledge of the biological, environmental and social causes of addiction and explains precisely how they interact over development. The theory is articulate and tight, yet made accessible and compelling through the author’s harrowing autobiography. Unbroken Brain provides the most comprehensive and readable explanation of addiction I’ve yet to see.”

Mar 13

12-Step Programs and Addiction: Myths Busted By David Sack

David Sack, MD, is an addictions specialist with a blog on Psychology Today called “Where Science Meets the Steps.” A couple of his posts as well as a recent article by him in the current print edition of PT are useful toward understanding some common myths regarding both 12-step programs and addictions recovery.

Whereas the 12-step myths in bold letters below are taken verbatim from the PT article, the quotes come from a previous post by Sack.

  1. You Must Believe in God True, Christianity figured into the development of the steps initially. And whereas choosing a “higher power” can still involve “a religious deity or entity…it can also be the power of a group working toward a common goal, nature or some other outside force. If you feel uncomfortable with the spirituality of a particular group, keep searching until you find a closer match.”
  2. You Are Powerless and Not Responsible “Powerlessness occurs because prolonged drug abuse changes the structure and function of the brain, and it takes time in sobriety to repair the damage. Powerlessness does not mean that the addict is inherently flawed, exempt from thinking for themselves or incapable of recovery, or that they can rely on their higher power to fix everything without taking steps to improve their own lives.”
  3. 12-Step=Dependency “In the early stages, people may benefit from frequent attendance, which often diminishes over time as they develop other support systems and become more firmly grounded in their recovery…If recovering addicts find that support in 12-Step meetings, they should continue to go. This type of ongoing participation in a program that improves members’ lives is very different from a destructive drug or alcohol dependency.”
  4. 12-Step Is a Cult “People are free to participate or not, and to take what works for them and leave the rest. There is hope that participants will embrace the wisdom of some of the 12-Step principles but they are also encouraged to think critically and to find their own way.”
  5. Too Many Rules Guiding principles and suggestions may abound, but not rules. The principles  “address specific deficits in learning, memory, empathy and other areas impacted by drug abuse.  Sharing stories, along with routinely scheduled meetings and oft-repeated mantras, for example,    help addicts remember the next right thing to do even when their thinking is still clouded by drugs.”
  6. 12-Step is For the Weak “The opposite of weak, it takes tremendous strength and courage to reach out for help. Some people may be able to recover on their own, but most cannot – and there is no shame in that. People with other chronic diseases do not expect to heal themselves, nor should addicts.”
  7. 12-Step Doesn’t Work The scientific and recovery communities disagree on this point. “Science has long dismissed 12-Step recovery, leaving a dearth of data where 75 years of history should provide much more, and 12-Step recovery has long rejected the need for and validity of scientific inquiry. But the necessary conclusion is not that 12-Step recovery doesn’t work; rather, the research, to date, has been inadequate.”

The following myths about addiction that Sacks believes can undermine recovery are from another PT blog post:

  1. Addicts are bad people who deserve to be punished. Rather, bad things often happen when addiction is involved. “Driven by changes in the brain brought on by prolonged drug use, they lie, cheat and steal to maintain their habit. But good people do bad things, and sick people need treatment – not punishment – to get better.”
  2. Addiction is a choice. “People do not choose to become addicted any more than they choose to have cancer. Genetics makes up about half the risk of addiction; environmental factors such as family life, upbringing and peer influences make up the other half.”
  3. People usually get addicted to one type of substance. Polysubstance abuse is actually now the norm, whether to create a better high or to use one drug to counteract another’s effects or to take advantage of what’s more available at the time. “People who abuse multiple substances are more likely to struggle with mental illness, which when complicated by drug interactions and side effects, makes polysubstance abuse riskier and more difficult to treat than other types of drug abuse.”
  4. People who get addicted to prescription drugs are different from people who get addicted to illegal drugs. Less stigma is attached to licit drugs, but they’re not safer. “When a person takes a prescription medication in a larger dose or more often than intended or for a condition they do not have, it affects the same areas of the brain as illicit drugs and poses the same risk of addiction.”
  5. Treatment should put addicts in their place. Shame is worse than ineffective, but unfortunately is still used in some addiction recovery centers.