Earlier generations were taught that addiction is a moral failing only curable with punishment. More recent generations were taught that addiction is a disease, though, still only curable with punishment. While addiction is a health issue, it is better understood as neither a moral problem or a disease, but rather a learning disorder. Leading neuroscience author Maia Szalavitz explains this definition in her book, Unbroken Brain: A Revolutionary New Way of Understanding Addiction. She refers to addiction as a relationship to drugs that is reinforced and influenced by our brain’s natural hardwiring.
The disease model disempowers people who need inner strength and support. A terminal disease takes away one’s power by debilitating patients and preventing them from advancing any further in life. Addiction can be debilitating, but believing the condition is just as permanent or intractable as late-stage cancer only makes one's condition worse. Many people are further disempowered by the nearly-ubiquitous 12-step treatment model because the first step is an admission of powerlessness, that one's life has become unmanageable. Shouldn’t the first step be making a conscious decision to take charge of one's life?
Our inclination to escape pain and seek pleasure comes from a survival mechanism that lives in the amygdala, a central part of our brains often called the” lizard brain” or “monkey brain.” Our brains are capable of learning how to move away from discomfort more rapidly with each painful experience because these pain-pleasure memories are stored differently than other memories. Each time a traumatized teenager chooses alcohol over sports or arts or meditation, they are more deeply encoding a piece of “software” that makes the decision to choose alcohol more automatic. The human brain isn’t fully capable of predicting consequences until about age 25, which means social-emotional learning and skills for coping with stress are especially important during our early years.
Struggling to meet basic economic needs, surviving abuse or disaster, enduring systemic bias, and adverse childhood experiences increase a person’s risk of developing or worsening a problematic drug relationship. People living in poverty, people of color, LGBTQ folks, homeless populations, people struggling to manage neurodivergence, and people with different physical abilities are more likely to be met with barriers to access treatment. These individuals are also more likely to be mistreated or not taken seriously when speaking with doctors and counselors. In short, their challenges worsen chaotic drug relationships and their ability to get help is compromised by prejudices in our education, criminal, and healthcare systems.
Simply by having a better understanding of addiction, society can better reduce drug-related harms and prevent problematic drug relationships. The policies we enact, the programs we design, the services we provide, and the research we conduct should first acknowledge that drug use itself is not necessarily the problem. Rather, problematic drug use a symptom of an underlying problem with its own consequences that can be addressed with help from others or on one's own -- with the right tools, of course.
Unbroken Brain: A Revolutionary New Way of Understanding Addiction, Maia Szalavitz
High Price, Dr. Carl Hart