Maia Szalavitz on a New Way of Understanding Addiction

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Maia Szalavitz on a New Way of Understanding Addiction

By Seth Ferranti 04/04/16

From shooting heroin in a Queens apartment to becoming one of the leading writers on addiction, this self-described “middle class white girl junkie” maintains that addiction is more akin to a learning disorder like ADHD or dyslexia than a disease.

Image: 
Unbroken Brain: A New Way of Understanding Addiction
via Author/Ash Fox

Wrestling with the science of addiction is a job unto itself. Surprisingly, a lot of treatment methods have remained the same throughout the history of substance abuse.

Have the terms “addictive personality,” “broken brain,” and “progressive disease” become outdated? Former Fix contributor Maia Szalavitz thinks so. In her new book, Unbroken Brain: A Revolutionary New Way of Understanding Addiction, she uses her own personal story—which includes shooting up coke and heroin 40 times a day and facing 15 to life for a kilo of cocaine under New York’s Rockefeller drug laws—as an investigation into addiction and, more importantly, how to effectively prevent and treat it.

What I think addiction really is, rather than a disease, is a form of overlearning or really intense learning that occurs in the circuitry that allows us to survive.

From shooting heroin in a Queens apartment to becoming one of the leading writers on addiction, this self-described “middle class white girl junkie” maintains that an addiction is more akin to a learning developmental disorder like ADHD or dyslexia than a disease. In other words, it’s not like cancer or hep C; it’s shaped by aspects in early childhood, it usually strikes the young, and people can outgrow it without any treatment. Maia is trying to dispel the notion of “once an addict always an addict,” the stigma that people hold true about those who have a “chronic brain disease.”

In our country, there are addiction treatment programs for everything imaginable, but most are based on the 12-step program that has been around since 1939. Maybe a little update was needed. Maia seeks to resolve controversies over treatment, prevention and policy that consider drug abuse a choice rather than an illness. But even though she battled her own addictions and won using the 12-step program, she doesn’t think she ever “hit rock bottom” or recovered from a “brain disease.” 

via Amazon

I chatted with Maia via Skype to find out about the 25 years of scientific research that went into her book, why she believes the 12 steps are outdated, and the groundbreaking new ways of addressing drugs and addiction that she's developed.

What do you think about the current state of treatment in our country today?

I think that 80 percent of all addiction treatments in the United States are based on the 12 steps. And while many people find the 12 steps helpful—I think that because it is available for free and in church basements—that’s not what you should get in drug treatment. I also think that because there are spiritual and moral elements of the 12 step treatment that are not involved in treatment of any other disorder, that it makes it very difficult for people to take addiction seriously as a health problem when the treatment tends to involve confession, prayer and meeting. We don’t have the multiple kinds of different therapies that should be available.

How do you define addiction?

I define addiction as compulsive behavior despite negative consequences. In the case of drug use, it's compulsive drug use despite negative consequences, and that’s the definition of a learning disorder. I think if there is another condition that it’s comparable to, I would say it’s like ADHD or depression. Both of these are mental illnesses that involve the brain that are shaped by what you learn over the course of development. There are both medical, psychological and social treatments that are useful for them. 

So when we look at addiction from a developmental perspective, we see that the vast majority of addictions occur between the age of teens and early 20s. There’s a specific phase of brain development that’s also going on at that time. When you look at other developmental disorders like autism, for example, that starts in early childhood. Schizophrenia starts in late adolescence and early adulthood, just like addiction does, so it fuses into the fact that there is a specific part of the brain that may be affected.

Addiction involves the search for love and connection, and sort of the ability to connect with other people and interact with other people, whether it is as a friend or parent or a partner. What goes wrong in addiction is basically that you fall in love with a substance instead of a person, and that makes you do all the crazy kinds of things people in love do, but in search of a drug.

How did the 12 steps help your recovery?

This will sound paradoxical, but for me, the only thing I was offered when I sought help—when I finally realized I needed to stop everything—was the 12-step program. And I embraced that because I didn’t have any other alternative. What I found useful in that was a very strong community that gave me a sense of meaning and purpose and connection, which is what I had been missing. 

But the reason I say that we should not base addiction treatment on the 12 steps, even though that is what happened to help me, is because I know now from the data that there are a lot of other people who aren’t helped. I do know from my own experience that there is a lot of moralizing and a lot of medical advice that is given by people who are not doctors. I can also say that one of the things that really, really helped my recovery was antidepressants. At that time, there was real opposition in the 12-step groups to people taking antidepressants, and there still is opposition to the use of other types of medication in addiction treatment today.

What are your thoughts on the connotations of calling addiction a brain disease?

I think it would be fair to say depression is a disease. I think it would be fair to say that schizophrenia is a disease. Mental illnesses are different in their symptoms than medical illnesses. It’s certainly fair to say that Alzheimer’s is a disease. Addiction is certainly not a disease like Alzheimer’s for the plain reason that many, many, many people get better from addiction and no one has gotten better from Alzheimer’s.

With addiction, the thing that makes it hard to see as a medical problem is that people actively make choices during their addiction. So people choose to put the drugs in front of their work, and they put the drugs in front of everything else in their lives, and that makes it look like, oh, they’re just choosing to do what they want to do, But that’s the same way that people behave when they’re in love. They put their lover first. They do all kinds of things to make sure they can stay together even when that might not be so.

What I think addiction really is, rather than a disease, is a form of overlearning or really intense learning that occurs in the circuitry that allows us to survive. Fundamental biological drives are going to persist in seeking those things, despite negative consequences, as long as they think their survival is depending on it. When a drug gets mixed up in that or even a compulsive behavior, you end up with people who have priorities that seem very weird to everybody else, but that are not shooting up in front of the police.

Why do you think you are the best person to write this book, and why now?

Because I was addicted to cocaine and heroin, and because I had developmental and temperament issues—that I think if I had been a child now, I would probably be described as Aspergers or somewhere on the autism spectrum. I think that allowed me to see how important the developmental part of addiction is; because for me, from day one, I was really different from other kids. I had a lot of sensory issues. I had a lot of fear of socializing. I didn’t like to be touched. I was very smart intellectually, but completely clueless socially. And so all of these things really made me stand out. 

Virtually all the neuroscientists who say addiction is a disease would not disagree with calling it a learning disorder, because you can’t have addiction without learning. What I mean by that is basically, if I take a drug and I learn that this drug is wonderful, then I can crave it. But if I take a drug and I don’t learn that the drug was the thing that had that effect, I don’t know what to crave. Babies can’t be addicted because they don’t know what to crave and they can’t go out and score. A baby can certainly be warm at first with physical dependence and suffer from that, but that baby cries just like any other baby cries, and he or she does not know what they want other than, probably, mommy.

What is the revolutionary new way to understand addiction?

I think we have some broad principles that can guide us. There’s a million ways to addiction, so there has to be a million ways out of it. If I became addicted because I was raped when I was a child—which is not in my story, but if it was—I would need something very different than if I became addicted because I have a severe OCD issue or something else. Treatment absolutely needs to be very individualized.

I certainly think that people who have addictions and their families need to advocate for themselves and just keep trying until they find something that works for them. But I also think that we do have some principles of what does work, and we certainly have some principles of what doesn’t work. 

For me, I do think that the general sense that community, connection, purpose, support, empathy—you kind of can’t go wrong with those. Some people may need antidepressants, some people may need a college education, some people may need a job, other people may need a child. This why the medical and moral do get tangled in conditions like addiction and depression, where some existential questions get in there. I think that the doctor should stay out of the existential questions. If we are going to confront our existential questions, we can choose to do that through church or temple or mosque or whatever the heck you want to go to, but I don’t think you can be prescribed by a doctor.

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