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People have often asked me to recommend a book about addiction. For thirty years, the only one I ever urged people to read has been the Big Book of AA, written eighty years ago, when we knew next to nothing about addiction. I’ll get into the reason why I recommended it in a minute. I’m happy to say that now there’s a better book for anyone interested in learning about addiction, drawing on the latest findings, written by an award winning journalist and recovering addict, Maia Szalavitz. Her book is Unbroken Brain: A Revolutionary New Way of Understanding Addiction.
The central premise to Unbroken Brain, is that we’re in the middle of an epidemic of addiction and we are stuck in treating it ineffectively when there are better methods available. She reports that one in ten Americans are in the throes of some type of substance use disorder. (The Surgeon General recently upped this estimate to one in seven) That doesn’t even count tobacco addiction and the myriad millions who have behavioral addictions to sex, gambling, shopping, etc; nor, one third of Americans who overeat and are said to be addicted to food. At the same time, pharmaceutical companies, tobacco companies, alcohol companies, agribusiness companies, casinos, lotteries, and every store at the mall all seem to know how to induce addiction for their purposes. We need some new ideas to help people, or, at least, stop recycling old ideas that don’t work.
The first idea that doesn’t work is throwing addicts in jail. Think about it; addiction is defined as using, despite negative consequences. Why then would we believe that applying negative consequences would treat addiction? It makes no sense, but we do it anyway.
I’ll tell you why we do it. AA taught us to. Yes, the Big Book of AA, that other book I told you about, the only one I ever could recommend, has taught us that addicts have to hit bottom, they have to lose everything and become totally humiliated before they will ever change. It’s a partial truth which justifies the drug war, mass incarceration of addicts, and many of the other degrading things we put addicts and their families through.
This is where I give you the reason I have never been able to recommend any book other than the Big Book of AA. It’s because the field of addiction has been so dominated by it, that no one has been able to go further, or contradict, the ideas found there. Almost everything else that has been written about addiction is based on AA principles.
When I began working in the addictions field, practically everyone else working as a counselor was a recovering addict. (If you want a full picture of what that was like, read my first novel, Fate’s Janitors.) AA had saved their lives. They were consequently devoted to AA and, when they wrote books and designed what were supposed to be professional treatment programs based on science and best practices, they just repeated AA slogans and principles. That’s fine as long as AA works, but frequently it doesn’t work; actually, a lot of the time, it doesn’t. Seventy percent of the people who try AA-like groups drop out within six months because it hasn’t been working for them.
If a doctor had a pill that seventy percent of her patients stopped taking before the course of treatment was complete, she might still prescribe it for the thirty percent that are helped; but she’d look for something else, instead of just blaming the patients for being uncooperative. In addiction treatment we blame the patients. We say they haven’t hit bottom yet. They have to hit bottom before they will get serious.
I didn’t enter the addictions field by first being in recovery. I entered it because I wanted to be a counselor and saw opportunities in addiction. When I began, I found that the counselors were treating clients very differently than they way I was taught to treat them in school. I was taught to respect clients, offer them unconditional positive regard, and put them in the driver’s seat. What I saw was the opposite. Chemical dependency counselors were very directive; they told people when and how they were full of shit, and made decisions for them. They said a client’s best thinking got them in this mess; it was not able to get them out. They said that an addict is lying whenever his lips are moving. When I objected, I was told things had to be different in chemical dependency. Addicts would take advance of my naiveté. My education had not prepared me for the real world. An addict’s mind was broken, they said, we can’t expect it to work like everyone else’s.
According to Szalavitz, they’re wrong and I should have believed what I was taught in school all along. Addiction does not break a brain, nor is it caused by a broken one. She characterizes addiction as a developmental disorder, like autism, ADHD, or dyslexia; which arises as an attempt to solve problems like trauma, interpersonal conflict, and sensitivity to stimulation, for which the person’s brain is not yet equipped; and one which resolves itself if the person is given the opportunity to learn from their mistakes. Indeed, the vast majority of addictions begin in adolescence and most end by the time the brain is mature around age thirty.
If we treated others who have a developmental disorder as we do addicts, we would tell the kid with dyslexia, for instance, that nobody could help him until he came to the realization that he was powerless over his dyslexia. We would punish him whenever he spelled a word wrong and, if he continued to do so, would throw him out of school, and maybe into jail. Not only would we fail to teach him, but we would call anyone else who had patience for him codependent and enabling. That’s not what we do with dyslexics, not any more, anyway; consequently, most compensate for their dyslexia and learn to read.
An over-emphasis on hitting bottom undermines AA’s other, more accurate, principle that addiction is a disease. It justifies the criminalization, discrimination, and humiliation of addicts. It spawns “tough love” approaches and the pathologizing of loved ones as codependent. It leads to abusive methods in many “therapeutic communities.” It leads to seventy percent of the people walking out.
There are many more points Szalavitz makes in this quite comprehensive book about addiction. She reviews in detail the connection between our drug policies and racism. She gives us the the dope on dopamine. She describes the twin hooks of wanting and having. She gets autobiographical, revealing her own transit into and out of addiction. But, for me, it is the counterpoint she provides to the last great book about addiction that is most valuable. Read Unbroken Brain if you need to understand something about addiction.
Click here to get Unbroken Brain on Amazon