Michael Bader: What causes addiction, and what can be done about it
August 9, 2016
Deaths from drug overdoses are reaching levels similar to the HIV epidemic at its peak.
If the war on drugs were a real war, we would have sued for an unconditional surrender long before now.
Heroin and prescription opiates seem to be today's drugs of choice, although addiction is an equal opportunity killer.
What causes addiction? And what is the best treatment for it?
First, let's dispense with some common misunderstandings.
Most of us believe that addiction stems from the power of the drug itself.
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That is, that drugs like heroin or oxycontin have an intrinsic power over their users who, upon using one of these special substances, come to physiologically crave that drug and fear withdrawing from it so much that they will do anything to get and use it.
In this view, there is an inherent chemical "hook" in various substances.
In the 1980s, experiments that seemed to prove this theory were very popular.
For example, a rat is put in a cage and is given the choice to drink plain water or water laced with cocaine or heroin.
The rat prefers the drug-laced water so much it gives up eating and eventually dies. The drug, in other words, creates the compulsion.
But as journalist Johann Hari and others have argued, further studies showed that the reality of addiction is quite different.
If the rat is placed in enriched surroundings — environments, for example, containing other rats, good food, puzzles to solve and objects that elicit interest — compulsive drug seeking stops almost completely.
The lesson is that if we have the opportunity to interact in communities and pursue activities with meaning and purpose, the drug loses its hold on us.
As Hari puts it, "The opposite of addiction isn't abstinence — it's connection."
This conclusion is borne out every day in 12–step recovery groups.
Addicts are welcomed into these groups with unconditional acceptance and actively encouraged to reach out and form relationships with other addicts, efforts that benefit all those involved.
There is a saying in these groups that "the power of one addict helping another is without parallel."
Suffering addicts are not excluded but told to "keep coming back."
Addicts in recovery could have predicted exactly what would happen to the rats who had been isolated in their cages.
Sure, there are likely biological and genetic factors that predispose people toward addiction.
And recovery groups certainly view addiction as a disease.
But while such a belief can alleviate the stigma and self-blame of the addict, it is only one part of an overall approach to curing addiction.
The other parts involve providing community and connection, meaningful work — and, sometimes, counseling — for help dealing with the emotional trauma found in addicts that almost always contributes to the addict's need to escape painful feelings and thoughts.
Portugal is a good case in point.
Portugal used to have the highest heroin addiction rate in Europe.
Reformers in the Portuguese government decided to revolutionize their approach to drug treatment.
In addition to decriminalizing most drugs and funding rehabilitation efforts, they subsidized employers who were willing to hire recovering addicts.
And the rates of heroin use and addiction plummeted.
Meaningful work, in other words, turns out to be one of the prongs of an effective approach to drug treatment.
We need to radically reform our approach to addiction.
While addicts may, indeed, have something wrong with their biology, and while they certainly do hurt and manipulate those around them, the answer does not lie in tough love or punishment.
"For a century now, we have been singing war songs about addicts," Hari says. "We should have been singing love songs to them all along."
Michael Bader, DMH, is a psychologist in private practice in Grass Valley. He can be contacted at firstname.lastname@example.org.
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