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(Almost) Everything Johann Hari Knows About Addiction is Wrong

It has been about a year since Johann Hari made a big splash with his book, Chasing the Scream. In the wake of its release was a Ted talk, several interviews, an article, and even a fan-created YouTube animation that all claimed opioids aren’t addictive; because if they are, we’d have an epidemic on our hands. It’s time to face it – Johann Hari was wrong.

What could have been an essential critique on the failed war on drugs instead became a contribution to an already saturated market of misinformation on addiction based on two central ideas: if opioids had chemical hooks, then there would be an epidemic due to the increase in opioid prescriptions for pain; and, if opioid-manipulating drugs were addictive, then people suddenly without access to their prescriptions pain killers would be buying heroin on the streets.

Two facts counter Hari’s argument. 

We are in the middle of an opioid epidemic; and when patients were cut off from prescription pain pills, heroin overdoses shot up. Since the early 2000s, overdoses from prescription pain killers have been steadily increasing. Drug overdoses now kill more people than car crashes with opioids contributing to over half of these deaths. When doctors realized the dilemma and became much more cautious when prescribing opioids for pain, many patients sought out heroin, an illegal opioid, on the street.

Hari goes on to present a solution for addiction: connection. Why connection? He got there by misinterpreting animal self-administration studies from the late 70s/early 80s, more specifically the Rat Park experiments. These were studies showing that animals, when put into environments with treats, toys, mates, and drugs, used far less drugs than isolated animals in cages. Subsequent experiments found similar results. Recent studies have found that only about 20% of animals used drugs over a sweet substance. There are two important take-away points from these experiments, and neither of them supports Hari’s idea. First, these types of experiments were critiques on the traditional animal addiction study while also showing the terrible effects of solitary confinement and harsh living environments. This applies directly to individuals in lower socioeconomic neighborhoods, where addiction may only look like addiction but is in fact a lack of better resources. This idea is not new, however; neuroscientists such as Carl Hart have advocated for better education of addiction in low SES situations. Experiments like Rat Park were an attempt to better emulate more natural drug taking conditions for people (i.e., people don’t use drugs in a vacuum). Thus, Rat Park didn’t produce an answer to addiction but provided translational validity for human addiction. The second takeaway is that a percentage of animal subjects continued to use drugs despite the enriched environment, and it was a percentage remarkably similar to people who try drugs and develop a substance-use disorder. This means that the Rat Park experiments, and subsequent studies replicating early results, provided further evidence of the addicting nature of drugs for a certain percentage of the population.

Don’t get me wrong, I like Johann Hari, and I like the other part of his book, the brilliant takedown on the failed war on drugs. That part was important for restarting the conversation and facilitated our understanding surrounding the problems related to crimes involving drugs. 

But, somewhere along the way with his book’s rise in popularity, the public started to pick up on this idea of addiction not being such a big deal after all. In a new generation of overnight self-help gurus, simple answers to complex problems might seem appealing, but newcomers, like Hari, do a disservice to the years of data collected and hard-fought, scientifically sound arguments to show that addiction is more than behavioral. It’s more than biology. It’s more than mental health. It’s more than socioeconomic status. In reality, addiction is a combination of all these things – which makes proper treatment difficult and something that can’t be reduced to platitudes.

If the public really wants to do something about addiction, then they could listen to those that have been studying addiction for decades. They could advocate for more standardized care, medication-assisted treatment, and education for practitioners. They could advocate for insurance to cover addiction like a health issue. It’s time to understand that treatment for addiction isn’t a one-size-fits-all approach. When someone goes to a psychiatrist for treatment of depression, they may have to try several medications and/or behavioral treatments before something works. With a growing number of promising medications and behavioral approaches to treat addiction, we could apply a similar model to addiction. The academic and scientific communities have a wealth of data from clinical-behavioral trials and an increasing repository of information on the neuroscience of addiction. It’s time to leverage that knowledge for the treatment of others. 

This article originally appeared on paulregierphd.com

Edit from AddictionUnscripted Staff: Paul has been a great contributor to AddictionUnscripted since day 1. He has a PhD in neuroscience. He is an addiction researcher at UPenn and writes about science, fiction, and science-fiction. Check out his website, listed above you won’t regret it!