Having processed Szalavitz's book Unbroken Brain in four previous installments, covering the philosophical, biological and temporal evidence she presents supporting the idea of substance use disorder as a learning disorder, the important question of "what to do about it?" arrives.

There are three posts covering her recommendations for action: yesterday, harm reduction; today, legalization; and Friday, education.

I know legalization of some mind-altering substances for adults is a hard idea to absorb. Old-school thinking says that people "should" (always beware of the "shoulds") go cold turkey when they quit, that it is only a matter of willpower, and a big stick like a prison sentence will help them find the willpower. How is that working out for us? Not well, says the data. We've been fighting a War on Drugs for decades now, and not only are we losing but we have created an ugly, foul, racist, classist system of abuse, mass incarceration, and death in its name. Examples:

• Nearly 80% of the people in federal prison and almost 60% of people in state prison for drug offenses are Black or Latino. (Drug Policy Alliance, 2019)

• Rates of heroin addiction in people making less than $20,000 are triple those for people who earn $50,000 or more. (Szalavitz, p,. 229)

• 13% of Americans 12 years or older were dealing with addiction in 2019, nearly matching the peak from 40 years ago. (SAMHSA, 2019)

• From 2010 to 2019, there was a 6.4-fold increase in opioid poisoning deaths. (BMC Medicine (journal), 2022).

That shows we are not winning the “Drug War”.

How would legalization help? For one thing, increasing controls on the quality and strength of the drugs available would create consistency, and eliminate any cutting with harmful substances like fentanyl, rat poison or xylazine, all major contributors to increased illness, suffering and overdose deaths . A second way would be that the struggle to procure would be reduced - the time, energy and fear - through dispensaries like we see for marijuana where it is legalized. The de-escalated “chase” to get the drug increases the quality of life of the user. The drama of procurement of the next fix actually contributes to the compulsive learning leading to addiction, as does the uncertain availability and dosing (p. 273); it's an insidious cycle. Remove the uncertainty, and the addiction isn't as strong. A third approach may be to make a small range of safer drugs legal, easily accessed and therefore attractive, to create the effect of reducing the demand for the more dangerous options, like opioids.

We can start by legalizing various harm reduction measures, currently illegal in most locations, as a way to test these principals. It is important to gather and analyze data to test what is working, and not rely on belief systems to assess.

Legalization is a stand-alone though. Recall too that alcohol, made legal again in 1933, is also a killer - 1 in 8 deaths of US adults 20-64 is attributable to alcohol (JAMA, 2022). And, marijuana is often legal now - cannabis impairments may be related to accidental workplace and driving deaths, and overdose deaths, especially among children and teens.

____________________________________________________________________

Tomorrow’s final post on Unbroken Brain: Education