By: Jason Smith
Let’s face it – for those of us in the world of addiction and recovery, the conversation can get stagnant. Much of what we believe about addiction is what we’ve been told, be it by counselors, or doctors, or 12-step literature. And much of what we’ve been told has been accepted as dogma, to remain unquestioned or undisputed.
Addiction? It’s a brain disease. No question about it.
An addict didn’t stay clean while working a 12-step program? It’s the addict’s fault. They were constitutionally incapable of being honest. The program is flawless.
As a recovering addict, I’ve always had a hard time walking that line between allowing a 12-step program to work for me – which, knock on wood, it has for going on three years – and believing every aspect of what we’re taught in meetings.
Someone relapsed while working the 12-steps? The addict in me wants to believe it was their fault, because that keeps things black and white, right and wrong. But the human being in me knows this isn’t the case, and that different people will require different treatment. There is no one-size fits all, despite what our literature tells us.
A disease? The addict in me wants to believe it’s a disease, because it would sure as hell explain a whole lot. But the father in me tells me that if my child was dying in the hospital of something like Leukemia, and you came along and told me your inability to stop getting high was also a disease, I’d tell you to go fuck yourself.
Like I said, I’m torn.
Then I had the chance to sit down and chat with author Johann Hari.
In Chasing the Scream, Hari takes a hatchet to recovery’s current belief structure, calling into question everything from our basic understanding of why people become addicted, to the fashion in which society punishes drug abusers. He followed up The Scream’s publication with a TED Talk that caught fire and went viral, culminating with every relative of mine on Facebook sending me a link to the video and asking me, “Jason, have you seen this?”
You’ve sort of become an accidental spokesperson for drug reform recently. Is that the position you wanted to be in?
I am very happy to be in that position. I mean, I am a journalist. I think the value of my book is in reporting. I traveled the world looking at the difference from what happens when you severely punish addicts, to when you show them love and compassion. The value in my book is not so much what I think, but in what is actually happening. Every conceivable approach, when it comes to addiction, has been tried somewhere in the world and it’s my job to report on this as a journalist, and let people draw their own conclusions.
I think you’re selling yourself a little short there. I found the value you bring in the book is your storytelling, your ability to capture the characters in these stories. You’ve humanized something much of society considers inhumane.
Thank you, that really means a lot. I’ve never said this publicly, but at the core of it, the War on Drugs can only continue through a process of dehumanization. We dehumanize addicts, drug users, and drug dealers. We have acted like they are people without feelings like us, hopes and dreams like us. And going and meeting these people, all I could think is, if someone reading my book can meet and get to know these people, they would not say that we should pursue a policy that makes it much more likely they will die. They wouldn’t say they don’t matter, their dreams and hopes don’t matter. They would see them as people like you or I, which they are. I see this book almost as a re-humanization. The reason why the book is written as stories of people is because at the end of the day, it’s hard to write someone off that you see as fully human. I wanted to sit with people and listen to them, listen to what their lives were like and describe it to the best of my ability.
Listening is kind of a lost art today. Everybody is really good at speaking their minds, but few people seem to listen to learn anymore. For me that’s one of the difficulties of what you’re talking about. It would require a social open-mindedness that we’re currently nowhere close to.
I think you’re right, and coming from a newspaper columnist, my job was to talk, and when I finished that, I wanted to adjust the ratio from speaking to listening in my life. It sounds cheesy, but just sitting with another human being and listening to what they have to say – it’s kind of amazing! One of the greatest privileges as a journalist is to sit and listen to a variety of different people. One thing I realized is how addicts can be heroes. I touched on how there was addiction in my life. But one of the reasons why the debate of addiction is so charged is because it runs through the heart of all of us, everyone who has been an addict or loves an addict knows, you are angry most of the time. There’s a bit of all of us who look at addicts and want to say “I WISH SOMEONE WOULD PHYSICALLY STOP YOU FROM DOING THIS.” Then there’s another part of us that knows that that doesn’t work because the way out of addiction is through compassion, and love and re-connection. And I think it really helped me to deal with some of the anger that I had, much of which I didn’t even know I had. Its empowering and energizing.
In your TED Talk you discussed the opposite of addiction being a sort of social connectivity for addicts, to be re-plugged into society instead of being isolated. I love that idea, and believe you’re 100% correct – but is it realistic? Is society ready to take the long, hard look in the mirror that would be required for this to happen?
I understand what your saying, but look at it this way: if we were having this conversation a hundred years ago, think about how women, African-Americans, and gay people were treated. If we were talking about the scale of change that needed to happen in order for them to all be treated with basic decency, it would be unbelievably daunting. But look at where we are today, just one hundred years later. I would say your totally right, we are facing a really big struggle…but big changes do happen and we’re the beneficiaries of those changes.
These changes only happened because people bonded together and demanded those things when it seemed incredibly unlikely that change would happen, and kept pursuing and fighting until change did happen. These things didn’t happen by accident. You are right we need a big change now, but I say that change is starting to begin.
Let me clarify. What you’re proposing values community over the individual, and I’m not so sure that can happen in such a hyper-individualistic, consumer-driven society. And to try and change that – that’s quite the task, exceeding the scope of just addiction. That would require a reexamination of our entire economic system, no?
But when you see people rediscover community, you see people that have been hungering for it all along. I don’t think, as individuals, we’ve chosen this grossly individualist society. It was more imposed upon us. It’s there because very powerful people got rich from this system. But it can be changed. Powerful people respond to the pressures put upon them. And the pressure from our side, to treat addicts compassionately, isn’t strong enough yet. We have to build up that movement and persuade more people. The more we do that, there will come a point where there is a person in power who will give into those forces over the pro drug war forces.
But what won’t happen, is nobody’s going to sit them down and explain to them why rationally the war on drugs is failing. That’s just not how it happens. It’s always been about power and bureaucracy and money, and those forces can be overwhelmed. The US is not a society entirely run by money. The most powerful programs in the US by far are medicare, social security, and military. And those are the three institutions in the US that are not run according to market principles and not run for profit. It’s important to stress, its not like the American people only want this extreme individualism. They love medicare, social security, and the military, and they are the most powerful and the least individualistic. It’s more we need to change the structures that promote this extreme individualism over all these other things.
It seems the current prescription drug epidemic in America has put a face to addiction that perhaps didn’t exist before, making it more difficult to stigmatize addicts and addiction.
You make a good point about the prescription drugs, but it’s important to understand why the prescription drug crisis is happening in order to know how to respond to it. We must ask why it’s happening now. I’ll draw a historical reference. Britain in the 18th century, loads of people were driven out of their homes to urban slums, and that started a thing called the “gin craze.” People were drunk in public constantly, and officials said at the time it was alcohol’s fault, that alcohol took over and hijacked their brains. Now when we look back on that, we know that wasn’t the truth. We know people were in terrible distress and despair and people were driven out of their homes into this disgusting place where they were given no hope at all, and a lot of them tried to ease their pain with alcohol. And a similar thing is happening right now with prescription drugs. If gin wasn’t invented back then, people would have found another drug to fuck themselves up with because people were in terrible pain and suffering. They needed something to be able to not be present in their own lives. If you have OxyContin, Percocet, its not about that individual drug. The biggest rise in the prescription drug crisis has been since 2008, which isn’t surprising. There was a huge economic crash, people found it harder to provide for their kids, harder to find jobs, so people turned to prescription drugs and still do.
But surely there’s a biological component that you’re ignoring, right? In your TED Talk you talked about the hypothetical guy in a car accident who’s given diamorphine in the hospital for two weeks, which is essentially medical grade, uncut heroin, then goes home and isn’t addicted. I can tell you as someone who had a pretty good life, but got that first taste of Dilaudid in the hospital and fell in love – the chemical component is much stronger than you’re giving credit.
I think its a mixture of things. Chemical hooks are very real, but its a small part of the picture. For example we know tobacco has the strongest chemical hook right? Its the most chemically compelling drug from tons of studies. So when they came out with nicotine patches in the 90s, there was a huge wave of optimism because the patches give you all the chemical hooks, but none of the unhealthy smoke. People thought loads of people would quit because their chemical hook would be met. Yet only 17% of people who use nicotine patches actually stop smoking. It shows that 17% will stop when they meet their chemical need, but there’s another 83% the other way. Don’t get me wrong, 17% is a lot of people, but equally the chemical hooks are a small part of the picture relative to anything else.
Now Jason, in terms of your story, I think we have to be wary about how we retrospect stories of our lives. What we know is that in a society if you have a big increase in social distress or pain, you will have a big increase in addiction, and if you have a fall in social distress and disconnection, you have a fall in addiction, so there is a close correlation. Every individual story in addiction is hard to know, but sometimes people say, “I had a good life, nothing was wrong and yet I became addicted” and what I say to those people is “ well you had a good life by the standards of our society.”
Shit, you caught me. I suppose there was some trauma there that I don’t like to acknowledge sometimes. What I learned from the drugs was they made the hurt not hurt so bad. The drugs were very good at that… for awhile, at least.
That’s a really good way to put it. 90% of people who currently use legal drugs do not become addicted. 85% of people who use meth do not become addicted. So its not about the chemicals. In Portugal when they used to punish addicts, addiction levels rose every year until 1% of the population were heroin addicts. Now they treat addicts with love and compassion, and they have had a 50% reduction in drug use, which hasn’t happened in Spain next door, which still has prohibition.
That’s why I’ve never been upset with the drugs for my own addiction. In a weird way, the drugs were there for me until I was ready to confront the issues in a more healthy way. Who knows how I would have coped had they not been there?
That’s such a good way of putting it. I have never talked about it in an interview, but there was a period in Vancouver when no heroin got into the US West Coast or Vancouver, and we know that because police would seize the drugs from the streets and do tests and there was no actual heroin in what they were selling on the street. If you believe the theory that the drug is this evil thing, that it takes people over, then what should happened to those people in this heroin famine? They should’ve gone through this terrible withdrawal, then woken up liberated from there drug. Yet what happened is that everyone carried on as normal. The addicts thought it was weak heroin but the dealers kept selling, people kept using, nothing really changed. There was a point when the war on drugs was won, and it didn’t make a difference. The drugs were stopped. And no one noticed a difference, because it’s not about the drugs. Its about the pain and about the need to not be present in your life.
Let’s say your drug was never invented. Do you think you would’ve been fine? No of course not, you would have found another drug like alcohol, or you would been in absolute misery. I think that’s important to understand. Its so easy and so tempting to project all our fears and hatred on this external object in the world and say if only we destroyed this external object, all these problems would go away. It’s so tempting but that’s not how life works.
What would you say has been the most fair criticism of you, regarding your outlook on addiction?
I could phrase myself better sometimes. Some people hear, in what I am saying, that I think personal individual compassion for addicts from their families is enough to pull them out of addiction. And what they think I am saying is that they didn’t love the addict enough because the addict remained addicted. That is absolutely not what I am saying. And I need to be more careful about how I talk about this sometimes.
You have gotten push back from some people in the 12 step community who believe addiction is a disease. Why do you think that is?
Well the overwhelming reaction from addicts and their families has been incredibly positive. But yeah, there has been a small number of people who have raised concerns, some which have been legitimate.
In terms of the twelve steps, I believe that for something as complex as human addiction we need to have a broad menu of options for people suffering from it. And different things will work for different people. There are people for whom the 12-steps work really well and all I have to say to those people is congratulations on your recovery, carry on with your good work, and I admire you. There are people I know who have been massively helped by 12-step programs. It’s a crucial thing that should absolutely be on the menu. However, there are a lot of people for whom the 12-steps do not work, and for those people we need to have different options.I don’t think we should take anything off the menu, apart from shame and stigma. But we also need to be realistic: for most people who enter 12-step programs, it doesn’t work. And even the people for whom it succeeds, they very often transfer to another addiction. Look at Bill Wilson, the founder of AA, or one of the founders of AA. He was a fundamentally good and decent man. It’s hugely to his credit that he was able to stop drinking with the support of the 12-step program. It’s also quite significant that he transferred to such heavy smoking that he gave himself emphysema and died at an early age because of it. It’s also highly significant that he transferred to sex addiction. That is in no way a criticism of the 12-step program, it’s just that there are incredible complexities to the human emotion and there are no easy answers.
And in terms of the question of disease I think it is very problematic, because addiction is not a brain disease. There is overwhelming evidence it’s not true. And there is actually evidence that it is a dangerous and harmful thing to tell addicts.But lets step back for a second. Why do people want to think addiction is a disease? There’s a good reason on their part, and one for which I don’t judge them for a second. I’ll draw another historical analogy. In the 1870s you had self-identifying gay people for the first time. And what you had was gay people for 2000 years being told they were evil and depraved, and when the first people started to self-identify, they said we are not evil, we are diseased. We are sick. And of course that was a huge liberation for them. Because if your only choice in life is to choose between being evil and sick, it’s better to be sick. It’s much better to be diseased than to be morally depraved.
Now of course we would think about homosexuality completely differently. They are not evil, they are not sick, they are just behaving in a way that doesn’t harm anyone. Now I don’t want to draw this analogy to tight with addicts. Clearly addiction is something that harms you.
And sexuality is also something that is genetic.
So it was no choice at all. In the same way I am not saying that people addicted choose to be addicted. Or that they should be judged for their addiction or that they’re morally flawed at all. That is the antithesis of what I believe. Lets look at the argument for people that believe addiction is a brain disease. They will look at brain scans of addicts and say they’re different from a “normal” brain. It’s true. The brain scan of an addict will look different, and they use that to support the disease concept. What they fail to understand is the basic concept of neuroplasticity. As you use your brain differently, your brain changes. Think about the arms. If I start lifting loads of weights, my arms get bigger. And it doesn’t mean I have an arm disease, it means I am using my arms differently. If I then stop lifting, my arms will shrink and my arms will get skinny again. This doesn’t mean I have a disease it means I am using my arms differently. The same is true of your brain. London taxi drivers have to memorize the streets of London which takes an incredible amount of knowledge, and if you do a brain scan of London taxi drivers, the part of their brain that correlates with spacial awareness is much bigger than in you or me. That doesn’t mean that they have a disease. It simply means they use their brains differently. The same thing is happening with addicts. The mistake these people who are looking at the brain scans are making is they are mistaking correlation for causation. They are getting the direction of causation wrong. Their brains are different because they use their brains differently. Its not the difference in their brain that made the behavior, it’s the difference in their behavior that made their brain different.
So you believe addiction is a case of classical conditioning?
Yes, and it’s really important to understand that. The second thing the people that make the brain disease arguments can’t explain is the phenomena of natural recovery. The vast majority of addicts stop on their own accord. They don’t go to rehab. It’s the norm for addicts and most addicts to stop without going to rehab or getting any treatment at all. If your brain has been hijacked and taken over, that makes no sense. But if we understand all these studies and even Rat Park and what these other experts suggest, it begins to make sense. Think about the soldiers that went to Vietnam. A quarter of the soldiers were using heroin and everyone thought there would be all these addicts returning from war. But loads of them stopped when they came back. See, these soldiers are like the rats in Rat Park. When they had very little decision, they chose the drugs. But when they came home to all this human connection they stopped using. And if you believe in the concept of brain hijacking, this doesn’t make sense and that’s because brain hijacking isn’t true.
But as somebody who has gone through dependence, addiction, and withdrawal, the idea that these soldiers just came home and didn’t suffer from, at the very least withdrawal, doesn’t make any sense to me. I’m not sure you understand the phenomena of obsession and craving. And even in this anecdote, the people who came back from Vietnam, got plugged into society and didn’t use – I don’t think anyone can come back from being a trained killer in a war zone and simply move on with their life. So the underlying cause of the addiction surely still existed. Somehow they coped with that. Maybe not with drugs, but if you’re a Vietnam vet with a smack habit, I don’t believe you just re-connect with society upon your return.
Sure, but the pain and trauma of coming home from war is different from being in a war zone where you could be killed at any moment. And the pain of dealing with something like PTSD can be really hard and take years to get over. But it is different. Obviously if I told you that people were going to come shoot at you in an hour, and were going to continue to shoot at you for the next three years…
That sounds like a pretty good excuse to get high to me.
But Jason there is one thing that I don’t want to forget mentioning. It’s not that the brain hijacking theory is wrong – it’s that its extremely dangerous to tell addicts this. There is this interesting study by Stanton Peele. He did a study that found that people who believe that addiction is a brain disease are significantly more likely to have a relapse than addicts who don’t believe that. And you can see how that makes sense if you’re an addict and I tell you your brain has been hijacked. Your brain has been taken over and fundamentally altered. You’re gonna have a different way of thinking about the world than if I tell you that you became and addict because you were dealing with terrible pain and suffering. And as we reduce that pain and suffering in your life, you are going to want to be present more and you’re going to want to use drugs less.
Those are fundamentally different messages and you can start to see how someone who has been told by people who seem smart, and seem to be scientists, that their brain has been hijacked – despite there being no evidence to support that. So that means if they relapse they are going to think, “What pain am I dealing with? How can I deal with that pain in a healthy way?” or thinking, “Fuck my brain is hijacked. This is just me, just who I am for the rest of my life”. There’s a very shocking statement by Charles Schuster in the book Brainwashed by Sally Satel. Charles was the head of NIDA, which was the main body supporting the brain hijacking theory. Charles stated that of course brain hijacking isn’t true – but it gets funding. That has really been a big driver in this brain disease model of addiction. Addicts don’t deserve sympathy and funding because they have a brain disease. They deserve it because they are in real suffering and they deserve our love.
But in active addiction, I’m not seeking your love. I can’t love you. I’m madly in love with my drug of choice. At best, you’re my mistress.
I think you’re totally right. What people hear when I say addiction is not a disease, they assume it’s a moral failing – but they haven’t even listened to me beyond the first sentence. I am very sympathetic to people who’ve gotten clean in a 12-step program. When you’re in a state of addiction, you want certainty and might not want to be told that actually there are a range of things that might work for you. This works for some people. However, in truth there are 20 things, some of which will work, some that will not. That’s not what you want to hear when you are in a state of chaos. I have got a friend who has breast cancer and I went to the doctor with her to talk about treatment and the doctor was outlining a range of treatments and all she wanted to hear was one thing that would work. Choices aren’t what you want when your suffering, but it’s what you need to be told, because probabilities and risk are real factors. There is no one thing that treats cancer; there is no one thing that treats addiction.
One thing that I do think is problematic about some people in the 12-step community is when there are people for whom the steps don’t work, they often blame the people that it does not work for. They believe there are people incapable of being honest with themselves. I am very uncomfortable about that. There are some people for whom AA programs are not right, because it is not good for them. And that doesn’t mean that that person is a failure or incapable of honesty, it just means it wasn’t the right program for them. Think about human grief. We all know people who grieve differently. And we would never say that there is one solution for grieving and if you don’t grieve this way, then you’re a failure and you’re just not honest with yourself. We would never dream of saying that. Addiction is a complex phenomenon. I want to say that I am in favor of AA and 12-step programs for the people that it works for. They are great and I admire the people who do it. There are number of things I admire about it. I think it provides a huge alternative to connect and to form community.
I got clean with a 12-step program, and I really believe the community and human connection is precisely what happens at these meetings. And Jesus, if there is a personification of Rat Park, it’s my Monday night meeting. It’s a place for people to connect. But I’ll admit, for me where it gets difficult is when people convince others that a 12-step program is the only way. This is the way that’s going to work and if it doesn’t work then it’s your fault. Having said that, I want to be careful not to poke holes in their belief system if those beliefs are keeping them clean.
In the 1930s and 40s, when the principles of AA were being articulated, they knew less than we know now. And there are no other phenomena that we treat in 2015 the same way we did back in the 1930s. It would be extraordinary if there was only one way to treat addicts, but that’s not the case. Not to discredit what they have done. But back then it was widely believed that alcoholics were suffering from an allergy to alcohol. And now we know that’s not true. It’s no criticism of them – it was the best they could do at the time. We know better now, and that’s ok. You can keep all the best parts of AA – all the love, community, all the non-judgementalness. Extract the spirit of AA but don’t be so fundamentalist about it.
I can sit here today with a few years clean and look at the 12-step program subjectively, and have this discussion, no problem. But on Day One – my first day clean after my life had fallen to pieces – I needed direction and a sense of certainty. Like your friend going to the doctor for her cancer, I just wanted to be told that something was going to work. Lie to me if you have to, but give me some sort of hope. I don’t think I would’ve been ready to be presented with a menu of options.
Firstly, we shouldn’t tell people things that aren’t true and it is not true that alcoholics or addicts have a brain disease. So we should not tell people things that are false. Secondly, I agree that people want certainty but I don’t think the doctor should tell my friend with breast cancer that there is only one solution, because if you are told there is only one way and you fail then you think it’s your fault, that something’s wrong with you. Or keep going back into this thing that isn’t for you. That to me isn’t a good idea.
Something that we have learned from harm reduction from all over the world is that some people just need to be kept alive while they continue using. The most important thing is keeping people alive and if the only thing keeping people alive is their drug, that is better than them being dead. There is a minority in the recovery community who attack harm reduction. For example Chip Somers, who is a very nice person, British guy, who was an influence on my friend Russell Brand for a while and continues to be a good influence on Russell’s life at the rehab center that Russell went to, often attacks harm reduction, saying that is just people continuing to abuse drugs. Even though I think Chip is a super nice guy and means well, that is a catastrophic thing to be telling people. Some people are not ready to stop and if they are not ready to stop, we need to keep them alive and not let them to die. And if they are left doing street drugs, there is a much higher risk of them dying. So I think that’s important for people to understand.
The other thing to realize is residential rehabs have an appalling success rate because it’s based on the wrong model. Particularly 30-day rehabs. If you took the rat out of Rat Park for a week and then put it back, it would very quickly go back to its drugs because addiction is a way of coping with suffering and pain. This is very similar to the 30-day rehabs, where we take them away for 30 days and put them in a nice house and charge them a fortune by the way, and then send them back to their terrible environment. Statistically, they overwhelmingly relapse. If you look at the success rate, they are atrocious. We need to look more at the Portuguese model, where we change the circumstances of their lives long-term. Something other than physically sending them away from their drugs and then sending them back to their pain and suffering. There are even abusive rehabs where you can train to work there within a year – they advertise for that! One year of training! Is their any other medical profession where you can train to work somewhere in under a year? Some people that work in rehabs email me and say “ Wow, we were never told any of this but it makes perfect sense.” Now I want to be clear- there are many people who work in rehabs that are very well intentioned. But if you look at the success rate of people who stop of their own accord, it isn’t any lower than people who go to rehabs. This shows that people are always recovering. You have got this extremely expensive industry. And the rehabs that are good and great places to go should be campaigning for more regulation and monitoring more results, because that way we can figure out what works and what doesn’t.
That’s always been one of our objectives at The Real Edition, to become a force that holds the industry accountable. Where it gets difficult is, that’s an expensive process. And usually, the only ones willing to fund it are the rehabs you’re trying to hold accountable.
Sure I agree. This is very similar to the regulation of the whole pharmaceutical industry. The rehab industry needs some regulation. There was a man in Kentucky who claimed he had a 99% success rate for addiction but it turns out they monitored their success through a letter from former patients. And 1% would write back saying I am still using. If your rehab center contacts you a year later and you’ve relapsed, how likely are you to tell them it didn’t work? So some rehabs have these very inflated success rates that can’t be proven.
I suppose that’s as good a place as any to close. Any final thoughts?
Every rehab center should have independent regulation and monitoring. They should be allowed to publish on their website, and a year later an independent regulator should find a representative sample of the people that have been there, and find out how much have they reduced their drug use, what proportion have achieved full recovery, and I guarantee you the results would be absolutely shocking. If we had cancer care, where the vast majority of people were dead a year later, wouldn’t we be changing – or at least re-evaluating – how we treat cancer?