Maia Szalavitz’s book, “Unbroken Brain: A Revolutionary New Way of Understanding Addiction” unearths new truths and challenges established societal and medical opinions on understanding and treating addiction. In light of the overwhelming public health crisis addiction has become, her ideas and theories are more salient now than ever.
The main takeaways from “Unbroken Brain” include the following:
1. Addiction is best understood as a learning disorder.
Addition as a learning disorder contains three critical components: (1) the behavior has a physiological purpose (to assist the brain/person cope in situations where he or she is either over OR under stimulated), (2) the specific learning pathways involved make it nearly automatic over time (particularly when an individual begins using a substance in adolescence), and (3) the behavior does not stop when it is no longer adaptive (i.e., use of a substance continues even when it no longer assists an individual with coping with over or under stimulation in their life). [p. 36].
2. Timing matters in addiction.
The time frame in which an individual is exposed to a substance matters. The most sensitive periods in brain developments are in infancy and adolescence, so if an individual is exposed to a substance during one of these times periods, he or she’s brain will be more sensitive to addiction. Further, the timing of taking the substance (habituation of consumption) increases the likelihood of addiction. Conversely, timing matters in preventing or combating addiction, and well-timed intervention can change an individual’s pathway towards addiction. [p. 44].
3. Genetics can predispose you to addiction, but they aren’t the determining factor.
Three traits serve as indicators for individuals with a high risk of addiction: (1) impulsivity and a desire for new experiences, (2) inhibition and/or anxiety, and (3) a combination of the two. All three of these pathways indicate the same underlying problem: difficulty with self-regulation. However, the mere existence of these traits does not predict whether one is an addict or not, but rather, whether the individual with these traits has a desire to use substances for a maladaptive purpose–i.e., to assist the person who is either over or under stimulated cope in their environments. [p.61].
4. Criminalization and moralization of addiction does not effectively combat addiction.
Criminalization and punishment of addiction has been shown, statistically, to not effectively treat or cure addiction. Further, the modern medical approach to addiction has typically been a combination of medical advice with a directing of patients to treatment centers and meetings centered on the 12 Step Program (i.e., Alcoholics Anonymous or Narcotics Anonymous). The underlying difficulty with these programs is that they moralize the behavior associated with addiction, rather than treating the underlying learning disorder. Nowhere else in modern day medicine is morality or religion introduced as a “cure” to a medical problem, and its singular use in addiction treatment is not only concerning, but generally ineffective.
In sum, addiction is a symptom of an individual’s maladaptive behavior that he or she has learned over time to assist the individual psychologically. Timing matters, as most addiction begins in adolescence, when the brain is undergoing significant change, and is most vulnerable to the influence of drugs or alcohol. Genetics plays a factor, but doesn’t explain all of addiction. And finally, our current AA and crime and punishment approach to addiction isn’t working–for society, or those seeking a cure from their addictions. Even if her theories do not resonate with you, her overall cry for a new, effective way to compassionately treat the increasing problem of addiction is something all healthcare providers should be able to get behind.