Drug addiction should be treated like a learning disorder – not a crime

People who misuse drugs are often jailed – the US has 25% of the world’s prisoners. But learning-based treatment would work much better

http://www.theguardian.com/commentisfree/2016/apr/05/drug-addiction-treatment-learning-disorders?utm_source=esp&utm_medium=Email&utm_campaign=GU+Today+USA+-+Version+CB+header&utm_term=165432&subid=13529055&CMP=ema_565

Since entering recovery 28 years ago, I’ve spent a great deal of time thinking about the conundrum of addiction. The most commonly accepted definition – the one used in psychiatry’s Diagnostic and Statistical Manual, the DSM – can be summarized as “compulsive drug use despite negative consequences”. It’s completely odd, then, that we treat punishment, which is just another word for “negative consequences”, as the best way to stop it.

During my addiction to heroin and cocaine in my 20s, I kept using despite getting suspended from Columbia University, which I’d worked most of my conscious life to be able to attend. I kept injecting despite losing friends – though difficulty socializing was one of the main reasons I took drugs in the first place. I kept on despite the risk of overdose death, disease, the disappointment of my family and the stigma.
And yet the US has some of the toughest drug sentences in the world. American drug policymakers expect fears and harsh consequences – like arrest and incarceration – to stop addicts like me from using illegal drugs. Instead, to begin addressing America’s opioid epidemic, we need to recognize addiction as the specific type of brain health issue it really is: a learning disorder – specifically, one characterized by failure to learn well from punishment.

Why is learning so important in addiction? For one, addiction can’t occur without it. If you don’t learn that a drug makes you feel better (at least at first) and then continue to take it to cope even when it does more harm than good, you can’t be addicted. If you don’t learn the connection between the drug and its effects, you basically wouldn’t even know what to crave, so you couldn’t pursue it.

Second, like other developmental disorders – such as ADHD, dyslexia, autism and schizophrenia – addiction unfolds as the brain matures through specific stages and the person responds to formative experiences. ADHD and autism, for instance, tend to start producing symptoms in early childhood, while schizophrenia does not usually appear until adolescence and early adulthood.

Addiction, too, is overwhelmingly a disorder of emerging adulthood. Ninety percent of all addictions begin during the teens and 20s. This isn’t coincidental: during this time, the circuitry of the brain involved in love and parenting begins to come online, and it is this same system that goes wrong in addiction. When vulnerable people – particularly those predisposed to mental illness and those who have experienced childhood trauma – reach their teens, they often learn that drugs ease their way into the social connections that are so important at this age.
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Essentially, addiction occurs when you fall in love with a drug rather than a person. Love wires memories into the brain very differently than learning abstract subjects like math typically does. And love requires that you persist despite negative experiences – no one could be a good parent or partner without doing so, at least to some extent. But if you bring that persistence and the sense that this relationship is crucial to your survival to your connection with a drug, serious problems can ensue.

The good news about addiction as a learning disorder is that the learning that occurs doesn’t “break” your brain. Instead, what happens is, again, very similar to the changes seen when someone falls in love or becomes a parent. These experiences profoundly shift values and priorities – and they can lead people do things that they otherwise wouldn’t. But they don’t eliminate free will, they simply skew it, which is why the relationship between addiction and choice is so difficult to describe.
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Still, just as most people can get over breakups, the same is true for addiction. Research shows that half of all addictions – including those to heroin and opioids – end by age 30, with the exception of tobacco. In my case, I quit at 23, right at the age when research suggests that the parts of the brain that maximize self-control finally become mature. I chose to attend rehab on my own, two years after an arrest for dealing, which had actually worsened my drug use by terrifying me about my future. It wasn’t fear of negative consequences that allowed me to quit.

The US incarcerates more people than anyone else; with 5% of the world’s population, we have 25% of its prisoners. Overdose now kills more people than car accidents. The war on drugs, with its complete misunderstanding of addiction, is a large contributor to the problem.

Understanding addiction as a learning disorder, then, has profound implications for all aspects of drug policy. If we want to do better, we need evidence-based treatments, prevention programs and other policies that recognize the role of learning and development – and we must stop trying to use punishment to fight a condition that is defined by its lack of response to negative experience.

 

Filed under: General Problems