Let’s start with what addiction isn’t. Addiction is not a disease. One problem with the disease model is that it’s disempowering to the people who experience it. A terminal disease takes away one’s power by debilitating patients and preventing them from advancing any further in life. Addiction can be similarly debilitating, but believing the condition is just as permanent or intractable as late-stage cancer only makes it more debilitating. Many people are further disempowered by the nearly-ubiquitous 12-step treatment model because the first step is admission that the individual is powerless over their drug of choice and that their life has become unmanageable. Shouldn’t the first step be deciding to take charge?
Leading neuroscience author Maia Szalavitz refers to addiction as a learning disorder. As detailed in her book, Unbroken Brain: A Revolutionary New Way of Understanding Addiction, addiction is a relationship to drugs that is reinforced and influenced by our brain’s natural hardwiring.
Our inclination to escape pain and seek pleasure comes from a survival mechanism that lives in the amygdala, a central part of our brains often called the” lizard brain” or “monkey brain.” Our brains are capable of learning how to move away from discomfort more rapidly with each painful experience because these pain-pleasure memories are stored differently than other memories. Each time a traumatized teenager chooses alcohol over exercise or meditation, they are more deeply encoding a piece of “software” that makes the decision to choose alcohol less and less conscious. With each repetition, those decisions become more automatic. Pair this with the fact that the human brain isn’t fully capable of predicting consequences until about age 25, and you have a perfect recipe for problematic teen drug use.
Struggling to meet basic economic needs, surviving abuse or disaster, enduring systemic bias, and adverse childhood experiences can increase a person’s risk of developing and/or continuing a problematic drug relationship. People living in poverty, people of color, LGBTQ folks, homeless populations, people struggling to manage neurodivergence, and people with different physical abilities are not always more likely to become addicted to drugs but they are usually more likely to be met with barriers to access treatment. These individuals are also more likely to be mistreated or not taken seriously when speaking with doctors and counselors. In short, their challenges worsen chaotic drug relationships and their ability to get help is compromised by prejudices in our education, justice, and healthcare systems.
Clarifying our understanding of addiction enables service providers to better support their drug-using communities’ needs. It encourages researchers to expand the line of questioning they use when considering experiments, too. Scientific funding nearly always goes toward research into the various ways drugs can be harmful, which further limits our understanding of drug use. Of course drugs cause harm, and it’s helpful to know how; what isn’t helpful is to keep research narrowly focused on problematic and dangerous drug use because it represents a small fraction of drug use across society. We need to examine the many different reasons and types of relationships that represent the full spectrum of drug use, including problematic, spiritual, medical, utilitarian, recreational, and experimental uses.
Simply by having a better understanding of addiction, society can better reduce drug-related harms and prevent problematic drug relationships. The policies we enact, programs we design, services we provide, and research we conduct should first acknowledge that drug use itself is not necessarily a problem. Rather, problematic drug use a symptom of an underlying problem that can be addressed on one’s own with the right tools or with help from others.
Unbroken Brain: A Revolutionary New Way of Understanding Addiction, Maia Szalavitz
High Price, Dr. Carl Hart