Second, given that addiction is a learning disorder, it isn’t necessarily a lifelong problem that demands chronic treatment and the acceptance of a stigmatized identity: studies find that the majority of cocaine, alcohol, prescription drug, and cannabis addictions end before people are in their mid-30s and most do so without treatment. Similarly, between one third and one half of children diagnosed with ADHD no longer meet criteria for it as adults, and treatment doesn’t seem to affect whether they outgrow the disorder or not, although it certainly can affect their ability to thrive. Finally, the learning perspective offers insight into other conditions—from anxiety disorders to schizophrenia, bipolar disorder to depression—that often pre-cede addiction and could benefit from similar approaches.
Challenging both the idea of the addict’s “broken brain” and the notion of a simple “addictive personality,” Unbroken Brain offers a new way of thinking about drugs, craving, and compulsions, whether seen in behavior as extreme as shooting drugs or as ordinary as dieting.
* * *
As I wait for the scanner to measure the soft structures under my skull, I can’t help but think about the organ that scientists consider to be the most complex object in the known universe. I know that all of our experiences are somehow written into our brains. Somewhere in the sinuous curves and pulsing surfaces of my own must be the echoes of everything I’ve ever learned, whether I can now recollect it or not, and every choice I’ve ever made, consciously or otherwise.
And somewhere in my gray and white matter are the neural structures that put me at high risk for addiction even before I’d taken drugs; here, too, is any lingering residue of chemical changes made by the substances themselves. Everything I am and everything I’ve ever been has at some point been represented here chemically, structurally, or electrically: not just addiction but now over 25 years of recovery and decades of other life experiences.
I hope that my scans can help me illustrate why learning matters in this disorder. After decades of reading, reporting, and writing on addiction, hundreds of interviews with experts, and even more with drug users and former users—many of whom have experienced addiction—I have come to believe that learning is the key to better treatment, prevention, and policy. While scientists have long recognized that learning is critical to addiction, most of the public does not—or is not aware of the implications of seeing it this way. However, trying to understand addiction without recognizing the role of learning is like trying to analyze songs and symphonies without knowing music theory: you can intuitively identify discord and beauty, but you miss the deep structure that shapes and predicts harmony.
Failing to recognize the true nature of addiction has also come at a catastrophic price. It prevents us from effectively tackling all types of drug problems, whether in terms of prevention, treatment, or policy. It buries the need for individualized approaches. It also keeps debates on these issues stalled in sterile arguments over whether addiction should be seen as a crime or a disease. Further, misunderstanding addiction allows drug policy to continue to be used as a political and racial football, since our ongoing use of ineffective tactics has produced widespread despair about affected people and families. In fact, however, research shows that, overall, addiction is the psychiatric disorder with the highest odds of recovery, not the worst prognosis—as many have been led to believe.
Addiction doesn’t just happen to people because they come across a particular chemical and begin taking it regularly. It is learned and has a history rooted in their individual, social, and cultural development. We think it’s a simple brain disease or a matter of criminal behavior because we don’t understand its developmental history and how that plays out in wildly varied ways to create a suite of problems that only look the same superficially. Understanding the role of learning illuminates what’s really going on and what to do about it.
Properly understood, the addicted brain isn’t broken—it’s simply undergone a different course of development. Like ADHD or autism, addiction is what you might call a wiring difference, not necessarily a destruction of tissue, although some doses of some drugs can indeed injure brain cells. While, like anything else that is learned, addiction may get more engrained with time, people actually have increased odds of recovery as they age, not reduced chances. This apparent paradox makes much more sense if seen as part of a developmental disorder that can change with life stages.
Moreover, as parents and teachers everywhere know well, it’s almost impossible to force or coerce learning—especially to alter behavior that has already become habitual. As B. F. Skinner himself observed, “A person who has been punished is not less inclined to behave in a given way; at best, he learns how to avoid punishment.” Fear and threat also literally shunt energy away from the areas of the brain involved in self-control and abstract reasoning—the exact opposite of what you want when you are trying to teach someone new ways of thinking and acting. Changing behavior is far easier if you use social support, empathy, and positive incentives, as a great deal of psychology research—though often ignored in addiction treatment and policy—demonstrates. This has obvious implications for the prospects of altering addiction via the criminal justice system.
Finally, the role of learning and development in addiction means that unlike in most physical diseases, cultural, social, and psychological factors are inextricably woven into its biological fabric. Pull any thread alone and the entire idea unravels into an incomprehensible tangle. Label addiction as merely biological, psychological, social, or cultural and it cannot be understood. Incorporate the importance of learning, context, and development, however, and it all becomes much more explicable and tractable.
Seeing addiction as a learning disorder allows us to answer many previously perplexing questions, such as why addicted people can make apparently free choices like hiding their drug use and planning to ensure an ongoing supply while failing to change their habits when they result in more harm than good. Learning helps explain why cultural trends and genetics can both have big influences and why addictive behavior is so varied. Further, learning and development elucidate why factors like employment and social support affect recovery in a far greater way than they do with physical illness. Sadly, cancer rarely disappears when someone falls in love and marries—but alcoholism and other addictions can and often do remit.
In the rest of this book, we’ll see just how intimately learning is involved in every aspect of addiction: from the molecular brain changes that result from certain patterns of drug use and experience to the associations between drugs and particular cues and memories that are mediated by individual, familial, cultural, and historical circumstances. Using my own experience as a case study, I’ll show how one addiction played out through one pathway and why others take different routes. Though my specific story is undoubtedly unusual, its particulars illustrate the universality of learning in the addiction process and why its singular nature in all cases is critical to understanding the larger problem.
Here, we’ll see how addiction affects a very specific type of learning, involving ancient brain pathways that evolved to promote survival and reproduction. Since those are the fundamental tasks of any biological organism, they produce highly motivated behavior. When starving, when in love, and when parenting, being able to persist despite negative consequences—the essence of addictive behavior—is not a bug, but a feature, as programmers say. It can be the difference between life and death, between success and failure. However, when brain pathways intended to promote eating, social connection, reproduction, and parenting are diverted into addiction, their blessings can become curses. Love and addiction are alterations of the same brain circuits, which is why caring and connection are essential to recovery, too.
The world is finally recognizing that the punitive American approach to addiction, which has dominated drug policy for the last century, is failing. In order to move beyond it, a new understanding of the disorder and its relationship to drugs and other behaviors is needed. Only by learning what addiction is—and is not—can we begin to find better ways of overcoming it. And only by understanding addicted people as individuals and treating them with compassion can we learn better and far more effective ways to reduce the harm associated with drugs.
As I lie in the scanner, a snippet of a Talking Heads song pops into my head. It goes, “Well, how did I get here?” That’s the mystery of every addiction—and to solve it, we need to look at it from an addict’s perspective, elucidating general principles by examining the specific and particular.
Written by Kelsey Allen