Unbroken Brain: A Revolutionary New Way of Understanding Addiction

348 Pages·2016·1.62 MB·English

by  Szalavitz

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Table of Contents
About the Author
Copyright Page

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To Ted
Special acknowledgment to the Soros Justice Fellowship Program, which supported the
completion of this book.
AUTHOR’S NOTE
Writing about addiction presents many challenges. One of the most difficult is
the omnipresence of stigmatizing and inaccurate language. Advocates have
successfully advanced “person first” language to describe people with other
types of conditions like schizophrenia and bipolar disorder, observing that
characterizing individuals entirely by their illness is dehumanizing. But this
advance has yet to reach most media coverage of addiction, which also spews
degrading terms like “junkie,” “drunk,” and “crackhead” in ways that are
inconceivable in other health reporting.
Consequently, I have tried throughout to use “person with addiction” or
“person with alcoholism” in place of “addict” or “alcoholic.” When I do use the
shorthand, it is only because the alternative would have been unduly clunky or
repetitive or because I am referring to a stereotype. Further, I have only included
the demeaning term “abuse” to describe drug problems when citing
unfortunately named government agencies or the now-obsolete psychiatric
diagnosis of “substance abuse,” which formerly labeled problems milder than
addiction. The preferred term for less severe drug problems is “substance
misuse,” which doesn’t automatically associate drug users with child abusers,
molestation, and domestic violence. (“Drug use” is the term for substance use
that is not associated with harm or addiction.)
Moreover, when writing about autism, I have used the term “autistic person”
rather than “person with autism” because that is the preferred language of many
autistic advocates. These activists see autism as intrinsic to who they are and
view saying “person with autism” as being similar to describing a woman as a
“person with femaleness.” I have also used “addicted people”—in this case, to
minimize repetition and awkwardness.
Finally, I want to note that in the memoir sections of this book, names have
been changed.
Introduction
There is often a struggle, and sometimes, even more interestingly, a collusion between the
powers of pathology and creation.
—OLIVER SACKS
I AM LYING ON MY BACK inside the thin metal tube of the brain scanner at the
Semel Institute for Neuroscience and Human Behavior at UCLA, trying not to
think about coffins and earthquakes. On my thigh is a rubber ball to squeeze in
case of panic, which can immediately liberate me from the giant white donut-
shaped machine; my head is now centered deep in the hole. Earlier, as I was
propelled inside on sliding rails, I couldn’t help but be reminded of the drawers
in which corpses are kept in morgues. Although I’m wearing earplugs, the
machine’s metallic roar—complete with occasional shaking and shrill beeping—
seems deafening. Since I am claustrophobic and abhor loud noise, I try to focus
on my breathing. One task I will perform here is supposed to measure impulse
control, but it is taking nearly all of mine not to immediately crush the squeeze
ball and escape.
I’m not being scanned because a doctor has ordered it. I’ve actually chosen to
put myself into this tight spot as part of an experiment. I want to understand
more about addiction: my own history of it and what it means more generally.
How did I go from being a “gifted” child and Ivy League scholarship student to
injecting cocaine and heroin up to 40 times a day? Why did I recover at 23,
when many others take much longer or succumb? More important, what
determines who gets hooked, who recovers, and who does not? And how can we
as a society do better at addressing addiction? As I wait in the scanner, I recall
the last days of my drug use, a distressing period in 1988 when I spent my time
either shooting up, selling drugs, or trying to buy. I consider what has changed—
and what hasn’t.
Sadly, had I nodded off in the ’80s and somehow been revived in 2015, I
wouldn’t find much different about how we frame and deal with addiction. Sure,
at least four states and Washington, D.C., have legalized recreational marijuana
sales. That would be shocking to anyone whose last memories were of the “Just
Say No” years. And yes, addictive behavior is back in the media spotlight,
though these days it’s not crack but Internet addiction, sex addiction, food
addiction, gaming addiction, and the tragic drumbeat of prescription overdose
deaths (celebrity and otherwise) that get the most attention. Overdoses are now,
in fact, the number one cause of accidental death, surpassing even auto fatalities.
Indeed, today, more people than ever before see themselves as addicted or
recovering from substance addiction: 1 in 10 American adults—more than 23
million people—said they’d kicked some type of drug or alcohol addiction in
their lifetime, in a large national survey conducted in 2012. At least another 23
million currently suffer from some type of substance use disorder. That doesn’t
even count the millions who consider themselves addicted to or recovering from
behaviors like sex, gambling, or online activities—nor does it include food-
related disorders. With the 2013 declaration by the American Medical
Association that obesity, like addiction, is a disease, up to one in three
Americans may now qualify due to their body weight.
At the same time, Big Pharma, Big Food, Big Tobacco, Big Alcohol, and Big
Business in general all seem to intimately understand addiction and how to
manipulate it. However, most of the American public—including most people
with drug problems and their families—do not. Trapped in outdated ideas—
many unchanged since the flapper days of Prohibition—we continue to recycle
the same tired debates and enforce counterproductive criminalization strategies.
But it doesn’t have to be this way.
I propose here a new perspective, one that could help end this stagnation and
suggest a way forward in treating, preventing, and otherwise managing addictive
behavior. As this book will demonstrate, addiction is not a sin or a choice. But
it’s not a chronic, progressive brain disease like Alzheimer’s, either. Instead,
addiction 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. This is clear both from abundant data and
from the lived experience of people with addictions.
Like autism, addiction involves difficulties in connecting with others; like
ADHD, it can also be outgrown in a surprisingly large number of cases.
Moreover, like other developmental disorders, addiction can be associated with
talents and benefits—not just deficits. For example, people with ADHD often
thrive as entrepreneurs or explorers, while autistic people can excel at detail-
oriented tasks and many are highly talented musicians, artists, mathematicians,
and programmers. Dyslexia can improve visual processing and pattern finding,
which is also helpful in science and math careers. Addiction is frequently linked
with intense drive and obsessiveness, which can fuel all types of success if
channeled appropriately—and some believe that the “outsider” perspective of
people with illegal drug addictions is linked with creativity. In all of these
conditions, the boundaries between normal and problem behavior are fuzzy.
Of course, in some ways addiction appears extremely unlike other
developmental disorders, most prominently because it involves apparently
deliberate and repeated choices, some of which, like taking illegal drugs, are
considered inherently immoral. Early-life trauma also can play an important role
in addiction, whereas it plays no role in autism. These differences mask
important similarities, however. In both autism and addictions, for example,
repetitive coping behaviors are frequently misinterpreted as the source of the
problem, rather than being seen as attempts at solutions. In fact, severely
neglected children often develop autistic-like behavior such as constantly
rocking as a way to soothe or stimulate themselves—and maltreated children
often appear to have ADHD because they are hypervigilant to “distractions” like
the sound of a door slamming.
In all of these conditions—including autism itself—repetitive, vigilant, or
destructive behaviors are not usually the primary problem. Instead, they are
typically a coping mechanism, a way to try to manage an environment that
frequently feels threatening and overwhelming. Similarly, addictive behavior is
often a search for safety rather than an attempt to rebel or a selfish turn inward (a
charge previously made against autistic children as well). We’ll see throughout
this book how misinterpreting understandable attempts at self-protection as
hedonistic, selfish, or “crazy” has needlessly stigmatized people with