A new definition of addiction
What if addiction treatment options have been barking up the wrong tree since taking form in the 1930's, just after Prohibition? That was the time when the concept of addiction as a disease was introduced. While clearly they got some things things right, the current lack of a reliable treatment option, one that would "cure" most sufferers, suggests that there may be a missing puzzle piece out there. The book I'm reading claims to know what that missing piece is. It is part of the research I'm pursuing to write about my brother Pete's life, and the addiction that took him away over three years ago. I'm learning a great deal about the science, psychology, social and political frameworks of addiction with the goal of writing about the broader topic and context intelligently.
One of the most referenced books I've encountered so far in recent scholarship on addiction - or, substance use disorder - is Unbroken Brain: A Revolutionary New Way of Understanding Addiction by Maia Szalavitz (2016, St. Martins Press). I'm just starting to read it and from the first moment I was fascinated by its thesis: that addiction is more closely correlated with learning disorders like ADHD, dyslexia and autism, and that this perspective would allow for new solutions.
Pete may have had ADHD, which according to this author would put him at increase risk of addiction. Pete underwent treatment for ADHD as a fourth grader, at eight years old. It was only for one year. That was back in 1968, when ADHD diagnosis was in its infancy, so it's hard to put a lot of stock in Pete's diagnosis. Still, his association with both ADHD and addiction is a circumstance worth looking at, if addiction proves to have a close relationship to learning disorders.
The concept of addiction as a learning disorder is a fascinating adjustment to the idea of addiction as a disease. Many sources I've read talk about the labelling of addiction as a disease being a double-edged sword. On the one hand, by classifying addiction as a medical condition, it removes from the person experiencing addiction most of the stigma and the blame for their addictive behaviors, and in the most serious cases, the progression of those behaviors. On the other hand, some have said it removes some of the free will and choice of individuals by putting substance users at the mercy of the medical establishment for solutions - and we all know how broken the health care industry is in this country, especially for a neuropsychological disease like addiction, one closely paralleling or even overlapping with mental health.
There isn't a clear standard for addiction treatment in this country for the moment. The current myriad of addiction treatment options (every clinic/program has its own version) out there are vague in their scientific basis, their medical and psychological approach and their success rate. In fact, the most successful aspect of current approaches is the 12-step approach, created in Alcoholics Anonymous in 1935, and that approach has nothing to to with medicine and everything to do with learning. The scientific and medical approaches to addiction are fractured at best.
OK, so what makes addiction like a learning disorder? According to Szalavitz:
The behavior has a psychological purpose. It eliminates anxiety, or reduces uncomfortable feelings, or creates a mental safe haven, or any of a number of other options.
Specific learning pathways - aka the brain's actual circuits - become nearly automatic and compulsive. Compulsive learning leads to a progressive addiction.
It does not stop when it is no longer adaptive. (first three, Unbroken Brain, p. 58) That is at the core of the definition of addiction - continuing the behavior "despite ongoing negative consequences" (DSM-V).
It takes shape during a particular phase of brain formation/circuit building, dependent on the substance and/or triggering or traumatic experiences involved.
(Unbroken Brain p. 61)
The most critical of these brain rewiring experiences are childhood exposures to mind-altering substances. A child's brain in various stages of formation is susceptible to being permanently altered by chemicals in ways that surprise medical professionals years later. More on that to come.
Meanwhile, I'll be back to report on what Szalavitz sees in later posts, including potential strategies for the future of addiction treatment, given a strong connection between addiction and learning disorders.
