NEW YORK — Author and reporter Maia Szalavitz, who writes about substance use and related issues, recently spoke with Youth Today and JJIE about her experience and her newest book: “Unbroken Brain: A Revolutionary New Way of Understanding Addiction,” released in April. Here’s Szalavitz’s take on addiction and its complexities, from her own experience and in her own words.
A sin or a learning disorder?
There’s traditionally been two ways of seeing addiction. Either it’s a sin and you’re a horrible bad person and you are just choosing to be a hedonist, or it’s a chronic progressive disease. While I certainly believe addiction is a medical problem that should be dealt with by the health system, the way we’ve conceptualized addiction as a disease is not actually accurate.
I see addiction as a learning disorder, and I can’t imagine there would be any neuroscientists who would say ‘No, learning is not involved in addiction.’ You have to learn that a drug fixes your problem in order to crave it, otherwise your brain wouldn’t know what to crave. That sounds very stupid and simple, but a lot of complexity goes into that. The very definition of addiction that is agreed on by most researchers and the National Institute of Drug Abuse, for example, is that it’s a compulsive behavior that continues despite negative consequences.
So, that basically means addiction is a problem of punishment learning, you aren’t learning from punishment, which is this horrible irony, because if addiction were solved through punishment, which is what we try to do all the time, the condition actually wouldn’t exist as defined.
The learning that occurs in addiction is generally different from the learning that occurs in people when they learn math or something. Addiction is when you fall in love with a drug instead of a child or a lover, and the learning that takes part in that part of the brain is designed by evolution to get us to persist despite negative consequences to do what we need to do. The problem is when that gets misdirected to a drug, and then you can find yourself in some very negative and potentially deadly situations.
The other reason I think learning is really critical in addiction is that learning is part of development, and we now know through neuroscience again that every mental illness, psychiatric condition, learning disorder, whatever, anything that’s really going on with the brain in some ways, has developmental components to it. So you don’t just wake up depressed from one thing, generally, there’s a whole pattern of things that go into it, your genes influence and the environment influences and your particular stage of development influences.
If addiction is misdirected love, how can that be redirected?
If addiction is misdirected love, and if addiction is compulsive behavior despite negative consequences, the thing people are going to need to get better is love, compassion and respect, not punishment.
Punishment by definition isn’t going to help. So what you need to do to help people to change and recover is to help them find different areas of passion and help them find better ways of coping. Because about 50 percent of people with addiction have a pre-existing mental illness, and about two-thirds have had some type of severe trauma during childhood and they are not using to the point where they’re risking their lives because it’s fun. They’re doing something to help them cope.
And so in order for people to recover, we can’t just say ‘love is all we need.’ Love is great and it does help a lot of people, but a lot of people have things like depression or schizophrenia or bipolar disorder or other disorders, all of which will need to be addressed in order for people to stay in long-term recovery.
And so because addiction is a developmental problem, the developmental stage is important, things like employment are important, things like having a sense of purpose, meaning and hope are important, and this is why there’s been so many spiritual cures for addiction, because those things often give people a sense of meaning and purpose. The problem is that we have a First Amendment in the country, and you can’t impose — or you shouldn’t be able to impose — a spiritual solution on people and it doesn’t work. You’re either amenable to that or you’re not, and so this makes it a very complicated problem.
Punishment is not going to fix it.
We should not be putting kids in cages and hoping that is going to fix their psychological problems of any type. Incarceration is as useful for addiction as it is for diabetes — that is, not useful and potentially harmful, particularly for kids.
There’s a lot of data that shows that if a kid gets put into the system — and we’re talking about kids who are selected for the same exact crimes — are way more likely to recidivate than kids who just happen to get away with it or kids who are diverted from the system. And there’s lots of studies on that, cross-culturally. What we’re doing is causing harm now.
For kids who are incarcerated for good or for ill, obviously what we need to do if we’re stuck with that is to provide dignified, respectful, homeopathic care as much as is possible in that setting. You really do need to feel safe and comfortable and hopeful that your life will get better, because if you don’t feel that way, why wouldn’t you get high?
People have just created irrational ideas that we just need people to suffer the most extreme consequences and then they’ll get better, and this whole idea of hitting bottom is not the answer. It’s a great spiritual story of sin and redemption, but it’s not a medical scientific thing.
Let’s say I hit bottom and then I get into recovery and then I relapse, and so now I need a new bottom, and then I cover again and I relapse again. You can’t tell if I ever really hit bottom until I’m dead. So it’s not useful; it’s a retrospective concept that also has been used to do an enormous amount of harm, like suggesting we put kids into prisons or throwing them out of the house.
You know, this whole notion of tough love, where you just cut these people out of your life, completely contradicts what we know. And what’s horrifying about it, particularly with a child, a teenager, is if you put a teenager on the street, you are putting them at extreme risk of way worse outcomes than if they are home with you. And if a child is doing something that is harming other family members or harming you or just putting other people at risk in some way, yes, something needs to be done about that, but don’t think that cutting the kid out of your life will help the kid. That is a real mistake a lot of people make.
[Related: Obama Affirms at Drug Summit That Addiction Is Disease, Not Moral Failure]
Parents really don’t want their kids hanging out with a ‘bad crowd.’ We want our kids with people who have good values and — as best a teenager can be — are doing well. When you put a kid into a system, you are basically putting them into a bad crowd. And I’m not saying the kids in the system are bad, they’re more deviant. And so you’re putting them in a situation like, ‘Wow, I smoked heroin,’ and ‘Wow, I did coke,’ and the kid is saying, ‘Wow, I only did pot, where can I get some?’ And so there’s this contagion of worse behavior.
So, what works?
If you’re worried about a kid and drug use, the safest, best thing to do is individual counseling or family therapy, none of which will expose kids to more deviant or problematic peers, and both of which are proven to be effective. At the very least, they won’t hurt. In a criminal justice setting, it’s very hard to create a therapeutic environment where people do feel safe, but the real important thing to do is to do your best to do that. Because the best outcomes that are seen for therapy intervention and for other psychological interventions is where the therapist really connects and the person really feels understood.
What about marijuana?
We absolutely should legalize marijuana. Marijuana is the least harmful psychoactive substance that we have, with the possible exception of caffeine. Since virtually any teenager you ask can tell you where to get marijuana anyway, it is unlikely that we could massively increase teen marijuana use.
I think, obviously, we really want to prevent kids from taking drugs. The best way to minimize this is to minimize harm. We’re never going to prevent every kid from doing something stupid during their teenage years. Your brain is primed to take risks; you’re primed to get into a social scene. [They’re going] to do things that we really don’t want them doing … so we need to reduce harm.
I don’t think there’s a single child who’s ever benefitted from being arrested for marijuana or for underage drinking. This does not solve the problem. It makes worse problems because a) it puts them into the system and b) it gives them a potential criminal record to have to deal with, and it can have consequences for school. The thing we want for all our kids is that they be connected with a learning community, and that they have strong social and familial relationships. If we can do whatever we can do to create that and to reduce bullying and to reduce the kind of pain and shame so many kids feel for so many reasons, that stuff is going to reduce addiction. It may not necessarily reduce use. But, again, 70 percent of my generation used and we created Steve Jobs and [Barack] Obama and [Al] Gore. We have to stop panicking over this stuff.
The worst thing you can do is to make kids so terrified that they’re not going to get into college or that they’re going to get thrown out of high school that when they overdose they aren’t going to call for help.
The most important thing to do is to make sure they stay healthy and alive. Again, that doesn’t mean we should tolerate the older kids teaching younger kids to use drugs … what we want to do is to reduce the reasons people use compulsively and reduce the harm associated with specific drugs.
We have to think in terms of harm reduction instead of ‘We’re going to get rid of this whole thing,’ because drug use has been with humanity before humanity evolved into humanity. You can see that elephants will get drunk, nonhuman primates will enjoy it, the cats will go for the catnip — it’s built into our biology. So we can either accept that people will seek ways of consciousness alteration and seek to reduce harm, or we can bury our heads in the sand and create more harm with the way we’re trying to stop it.
What about our current drug laws?
The thing about our drug laws is that they’re not based on science. Science could never get you to make alcohol and tobacco legal and marijuana illegal. Only racism can do that. And that’s what we have. We have a system that was devised by racists to create racist ends.
And I know that sounds really extreme, but if you just look at the history, you will find Harry Anslinger [first U.S. commissioner of the Bureau of Narcotics] going on about satanic swing and how reefer will make black people think they’re as good as white people — which to him, obviously, was a very horrible outcome. This is the basis of our drug laws. We have cocaine laws because they thought cocaine would make black people impervious to bullets — if only, right? It’s pseudo-scientific at best. You see this stuff in the New York Times in the early 1900s. It’s not obscure. So once you know the history of our drug laws, you have to say it is just based on nothing.
Do we really want to base our 21st-century policy on what the colonialist preferred at a certain time in history, not at all based on health or what the preferences of different cultures might be? That’s just ridiculous. I think our drug laws need to be made scientifically, as best as possible, recognizing that values will always be part of that.
Beyond science, how did your background help form your views?
I don’t have kids, but I’ve often noticed when people first become parents they seem to completely forget their own adolescence and they start to, as their kids become teenagers, try to do the things that didn’t stop them themselves. And I jokingly frame this as: Your brain gets wiped of those memories when you become a parent.
I also had my own addiction to cocaine and heroin in my 20s. I knew that it was driven not by the things the drug workers were telling me; in fact, I couldn’t believe any drug information that was given to me by authorities because I knew from my own experience that it was wrong. So when you’re telling me that marijuana’s going to make me crazy and addicted, and it doesn’t happen, why would I believe you about the other things? And obviously there are greater risks associated with some other things. And the reason I ended up taking those risks, I eventually learned, was not because I was some horrible creature that is evil and bad and wrong, but because I was wired slightly differently, and I found that these substances allowed me to connect socially, allowed me to feel OK and not overwhelmed by my sensory issues and emotional dysregulation. So, having had that personal experience, I knew that a lot of the stuff that we say about these things is just wrong.
Having the personal experience made me understand a lot more. That’s not to say I can speak for everybody with addiction. I think there’s a huge range of experiences.
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We Need to Talk with Youth About Substance Use
