Reframing the Addiction Problem

Right now everyone knows that the United States is in the grip of a full blown drug addiction epidemic. The nuts and bolts of how Purdue Pharma flooded the market with cheap high-powered synthetic opiates or the sobering statistics on which state had the most overdoses last year have all been examined in great detail, but left out of the analysis is a real honest look at addiction itself.

Depending on the personality characteristics of who you ask, addiction is one of two things: Either it’s an absence of willpower, or a medical disease.

Ultimately both of these concepts are flat out wrong and throwing your lot in with either perspective won’t be a productive enterprise. The idea you can just resist drug addiction via sheer strength of will is dangerously naive and essentially justifies a cavalier dismissal of the entire problem. It might feel good to drop a hamfisted social media post about killing drug dealers and locking up addicts, but like all empty internet bravado it’s about as productive as “thot patrolling“.

On the other hand, the problem with the disease model of addiction is that you are ceding treatment of the issue to the medical community, the very same point of origin for the current public catastrophe. Fundamentally the response of medicine to drug abuse has been to simply exchange one psycho-active substance for another, first was morphine for opium, then heroin for morphine, then methadone for heroin, and now buprenorphine for all of the above. The main driver of this approach is nothing more than the financial interest of pharmaceutical companies. More troubling, this scheme also reifies addiction into a “chronic disease” and permanent condition when it is nothing of the sort. We know from research that telling people they have no control of something increases socially undesirable behavior. 

So what is addiction? Addiction isn’t heroin. Addiction isn’t cocaine. Addiction isn’t the drug itself. Addiction, as near as I can gather with my admittedly limited background, is a learning process that has identified and reinforced a neural shortcut. In many ways shooting up drugs is a skill like riding a bicycle. The entire process from obtaining the heroin, to preparing it, to finding and accessing a vein becomes a set of subroutines the brain can operate on autopilot, much like when I clip into the pedals of my roadbike and frustrate dozens of impatient motorists for two hours. I don’t have to consciously think about balancing the bike, it happens automatically. The brain actually learns to create reward pathways for individual steps in the process of obtaining drugs, a crucial nuance that’s easy to miss. Just the needle in the vein or the bottle in the hand triggers a massive hit of dopamine, a process I’ve witnessed first hand in addicts receiving placebos that they honestly believe are stronger than the real drug.

Thinking about it in my own life, in days gone by when I was a bit of a womanizer, I developed the ability to unconsciously gauge which women in a random social context were open to my advances. There was nothing remarkable about this, if I stopped to really catalog and dissect this process the cues would’ve been pretty obvious to anyone. But it all happened on autopilot, much like the social instincts that guide drug addicts to other junkies in similar settings. Then as I flirted with these women, the hits of dopamine I got from extremely subtle signals of reciprocity reinforced the pattern of behavior. Like a drug addict, just the social dance of flirting and getting ever closer to sealing the deal became as powerfully addictive as the reward itself, much like the ritual of obtaining and preparing the drugs gives the addict an intoxicating level of satisfaction.

Eventually I found myself in a situation where this pattern of behavior had become compulsive, I was juggling three different women at once, caught in an entire web of lies and manipulation. It wasn’t even about the sex anymore, it was about the chase itself. Between the havoc it was wreaking on my personal life and the damage it was inflicting on perfectly good, vulnerable women, I eventually felt the problem was genuinely out of control. So I did the responsible thing and talked to a professional about it. Like any junkie, I felt a great deal of shame for what I done to other people and it demarcates the one period in my life where I had serious regrets about my actions.

Like any addiction, there were identifiable causes for what precipitated the compulsion, but once it started, it became a self-reinforcing positive feedback loop (neurologically this involves the striatum and midbrain) that got out of control. From an outside perspective it can be difficult to understand “how things get to this point”, but when you’re in the grip of this type of behavior your brain is highlighting the target of your addiction so intensely you lose any sense of the past or future. As everyone remembers from classic discussions about time preference, this is delay discounting and creates an overpowering “now appeal” to the object of the compulsion.

Addiction isn’t a hijacking of the brain, it’s just the brain doing what it does best, which is learning shortcuts to desired goals.

So how do we fix it? First we need to acknowledge the one other little detail no one seems to mention: Most addictions subside by themselves without treatment. That’s right, even cocaine addicts tend to quit over the course of their lifetime at a rate of 99 %. The remission rates for benzodiazepines, opiates and other similar drugs exceed 95%, with most dependency ceasing by the patient’s early 30s. 

Obviously what we really want to accomplish here is altering that natural trajectory so that individuals struggling with addiction quit using sooner and don’t suffer lethal overdoses. The real crime is how much of your life is robbed by a transient phenomenon that strikes in the prime of your youth. Future discussion will center around approaches to resolve addictions early. While I think there is some efficacy in conventional models, the rates of success are not terribly inspiring. Moreover I think there is a sad tendency for the families and friends of addicts to hand the afflicted over to a bureaucratic “system” or process with an unreasonable expectation of instant improvement instead of behaving like a genuine community capable of caring for their own.

If you wanna fix it, first you have to understand it, and then you have to commit to the hard work involved.

“And whosoever of them ate of the honey-sweet fruit of the lotus, had no longer any wish to bring back word or to return, but there they were fain to abide among the Lotus-eaters, feeding on the lotus, and forgetful of their homeward way. These men, therefore, I brought back perforce to the ships, weeping, and dragged them beneath the benches and bound them fast in the hollow ships; and I bade the rest of my trusty comrades to embark with speed on the swift ships, lest perchance anyone should eat of the lotus and forget his homeward way.” -Homer

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