Addiction: We May Need to Change Our Thinking

Patient Expert

You may have seen this week on your FaceBook feed a TED Talk by author Johann Hari, provocatively titled, Everything you think you know about addiction is wrong.

You also may have come across his Huffington Post article, The Likely Cause of Addiction Has Been Discovered, And It Is Not What You Think.

Both the TED Talk and HuffPost piece are based on his recent book, Chasing the Scream: The First and Last Days of the War on Drugs.

Here on HealthCentral, I have reported on how alcohol and substance use can seriously complicate the course of bipolar, in effect turning a challenging but treatable illness into one virtually impossible to manage.

The established medical theory behind addictions is that repeated exposure (to either substances or pleasures such as gambling) sensitizes the brain to insatiable cravings. This may involve a dependency on a single chemical (such as nicotine or alcohol) or it may set up a conditioned reaction in the pleasure/reward/anticipation regions in the brain.

Most likely, a combination of the two is going on. For instance, in anticipation of a nicotine or caffeine fix, the pleasure-seeking dopamine pathways will light up.

Genetics is a major component: Some people are particularly vulnerable. So is environment: Finding a new group of friends may work wonders.

But suppose all this is wrong? Or, at best, only a small part of the picture?

In his TED Talk and Huffington Post piece, Mr Hari brings up the famous 1980s Partnership for a Drug-Free America ad featuring a caged lab rat overdosing itself on cocaine. The ad was based on earlier scientific studies involving caged rats.

In the 1970s, Bruce Alexander of Simon Fraser University in Vancouver challenged these findings. Instead of isolation cages, he and his colleagues created a “rat park” with toys and tunnels and companions. These rats mostly shunned the free drug supply. They had better things to do.

The caged and isolated rats, however, became heavy users. But when these animals were moved into the rat park, after a brief period of withdrawal, they opted for normal lives.

For decades, the addiction establishment ignored Dr Alexander’s findings. In recent years, however, Dr Alexander is gaining currency.

Mr Hari also cites a natural human experiment: One fifth of those serving in Vietnam became addicted to heroin. Experts were concerned about what would happen when these soldiers returned home. As it happened, 95 percent simply stopped using. In Hari’s words: “They shifted from a terrifying cage back to a pleasant one, so they didn't want the drug any more.”

We also have the example of surgeries involving patients given diamorphine, the medical name for heroin. Strangely enough, despite months of use, these patients return to their lives with no addiction.

Finally, we have the work of the Dutch researcher Peter Cohen, who argues it is all about connections. To quote from Mr Hari’s TED Talk:

Human beings have a natural and innate need to bond, and when we're happy and healthy, we'll bond and connect with each other, but if you can't do that, because you're traumatized or isolated or beaten down by life, you will bond with something that will give you some sense of relief. Now, that might be gambling, that might be pornography, that might be cocaine, that might be cannabis, but you will bond and connect with something because that's our nature. That's what we want as human beings.

Of course, our whole drug policy is based on isolating and punishing these individuals and thus insuring they never integrate back into society. As Mr Hari concluded in his TED Talk, to a standing ovation:

For 100 years now, we've been singing war songs about addicts. I think all along we should have been singing love songs to them, because the opposite of addiction is not sobriety. The opposite of addiction is connection.

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Further reading …

The Cruel Double Whammy: Bipolar and Alcohol or Drug Abuse

The Bipolar and Alcohol and Drug Abuse Double Whammy: The Conversation Continues

Bipolar and the Self-Medication Issue