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Drug Addiction and Alcohol Use Disorder: The Facts, The Fiction, and How to Treat It

How addiction and alcohol use disorder (AUD) in the United States is approached has proven ineffective, punitive, and inadequate, according to many experts working in the field. Johann Hari, a Swiss-British writer and journalist covering the war on drugs gave an illuminating TED talk in 2015 that dug into how the punishment of addicts increases suffering and exacerbates the problem. In the U.S., addicts are punished believing that would deter them by providing an incentive to stop. Instead, drug and alcohol use are as bad as ever with more than 20 million people nationwide suffering from drug and alcohol abuse and the American taxpayer shouldering approximately $700 billion a year for treatment and incarceration. So, Hari stated, “almost everything we think we know about addiction is wrong, and if we start to absorb the new evidence about addiction, I think we’re going to have to change a lot more than our drug policies.”

It’s About One’s Environment, Not Solely Chemical Dependence

Most people believe the chemical hooks in drugs are what make one an addict. However, experiments over the years have destroyed that myth. Hari references the rat put in a cage, alone, constantly going to a water bottle laced with heroin or cocaine as opposed to the one with just water. However, in the 1970s, Professor Bruce Alexander ran another experiment, putting the rat in a cage he called “Rat Park” that included loads of cheese, colored balls, tunnels, and other rats. There were also two water bottles like the previous experiment. But in Rat Park, they almost never use the drug water, going from “almost 100 percent overdose when they’re isolated to zero percent overdose when they have happy and connected lives,” Hari pointed out.

A human and real life example of this experiment played out in the 1970s when 20 percent of American troops who used tons of heroin returned home from the Vietnam War. Many citizens were worried about these “drug addicts” coming back stateside. However, The Archives of General Psychiatry (now JAMA Psychiatry) revealed in a study that these soldiers did not go to rehab or into withdrawal. In fact, 95 percent of them just stopped. Addiction is not solely about the chemical hook. Rather, “What if addiction is about your cage? What if addiction is an adaptation to your environment?” Hari asked.

It is important to note that almost all functioning members of society are not drunk or high all of the time, despite nothing technically stopping them. Why is this? “It’s because you’ve got bonds and connections that you want to be present for,” Hari indicated. “You’ve got work you love. You’ve got people you love. You’ve got healthy relationships. And a core part of addiction, I came to think, and I believe the evidence suggests, is about not being able to bear to be present in your life.” Most individuals who use drugs and alcohol, do so to numb themselves from their thoughts and emotions because they cannot fathom the thought of feeling everything and being present during every moment of their lives. They cannot bear to be their normal sober self because the environment they are in is dark and depressing and ultimately unfulfilling to them. They do not have work they love. They do not have people they love or connect with. They do not have healthy relationships, especially with themselves. So, it is not only about the drugs and alcohol, it is about the environment one inhabits that can drive someone to addiction.


The War on Drugs, Mass Incarceration of Addicts, and an Exacerbating Problem

Addicts are regularly punished, shamed, given criminal records, and faced with insurmountable barriers between them and reconnecting with the rest of society. Dr. Gabor Maté, a physician with a special interest in childhood development and trauma, once said to Hari “if you wanted to design a system that would make addiction worse, you would design that system.” What is America doing wrong?

In 2000, Portugal had a devastating drug problem on their hands. One percent of its population was addicted to heroin and the Portuguese tried the American war on drugs model more and more which only made the problem worse. Eventually, the Prime Minister and the opposition party convened and decided to try something drastically different. A panel of scientists and doctors concluded that the evidence revealed that they needed to decriminalize all drugs from cannabis to crack. In addition, all the money they used to spend on jailing and criminalizing addicts would be used to help reconnect them to society.  So, this money went from mass incarceration to residential rehab, psychological therapy, and job creation programs for addicts.

What was the result of this decriminalization? In the years since that experiment began, drug use is down in Portugal by 50 percent, according to The British Journal of Criminology. Overdose is down. HIV is way down. Addiction is significantly down. And no one wants to go back to doing things the old way.

The U.S. is far from the most connected society on Earth in the age of social media. When “you have a crisis in your life, you’ll notice something,” Hari said. “It won’t be your Facebook friends who help you turn it round. It’ll be your flesh and blood friends who you have deep and nuanced and textured, face-to-face relationships with.” In turn, the number of close friends the average American can call on in a crisis has been steadily declining since 1950 while the amount of square footage in one’s home has exponentially increased. Hari concluded, “We’ve traded floorspace for friends, we’ve traded stuff for connections, and the result is we are one of the loneliest societies there has ever been.”

A Spiritual and Scientific Road to Recovery

A spiritual and scientific approach to recovery should be undertaken for addicts to turn their lives around. Compassion is needed and a wholesale change should be emphasized to aide those suffering from drug and alcohol abuse. 90 percent of the people who suffer from AUD and other substance use disorders get no help at all, instead, they get punished, ridiculed, and incarcerated.

What can the U.S. do differently?

  1. Dr. Anderson Spickard, Jr., an Emeritus Professor of Medicine and Psychiatry at Vanderbilt University Medical School thinks a “partnership between science and spirituality” works with people from all walks of life, including “people whom society has written off as hopeless addicts.” Spickard believes that “combining medical and spiritual approaches” will help many stay on the road to recovery.
  2. In The Craving Brain: Science, Spirituality and Recovery, by Dr. Spickard, James (a homeless addict) “describes in illuminating detail his long journey through the 12-steps. This slow, painstaking process bought him the time and experience he needed to rewire his brain—this time, not for addiction but for recovery. For James, as for some of our homeless men, the result was a spiritual awakening, a sense of surrender and letting go, that further empowers addicted individuals to stay on the long road to recovery.”
  3. Ned Hallowell, a child and adult psychiatrist and leading authority in the field of ADHD emphasized the fact that AUD and drug addiction is treatable. “Contrary to what most people believe, it is a treatable disease,” Hallowell stated. The knowledge and tools are available to provide a significant chance at a rewarding life.
  4. Our moral model with AUD has failed, Hallowell wrote, because we “blame the sufferer for having the disease. We see the disease not as a disease at all, but as a moral failing. We scorn the sufferer, exclude him, avoid him, and avert our eyes when he panhandles.” Hopeless addicts should be treated with respect, even if society thinks they don’t deserve it.
  5. Most still blindly believe the centuries-old moral model that a majority believe has failed millions of addicts. “Scorn the addict. Punish the addict. He made his bed, let him lie in it,” Hallowell lamented. Instead, these suffering individuals deserve respect and the benefits science has taught our medical community should be prescribed toward treating the “chronic, usually crippling, sometimes fatal brain disease called AUD.”

In conclusion, the remedy for addiction should be connection. The addicted individual should be treated with love, compassion, and connection. Why? Hari believes it is “because the opposite of addiction is not sobriety. The opposite of addiction is connection.”


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