Wednesday, January 5, 2011

Musings: Rethinking Addiction

The picture told the story. Even before I read today’s article, in which the father of murder victim Aureo Moore told of his son’s addiction to oxycodone, I knew from the vacant eyes in that first photo that Aureo was a lost boy, a junkie.

I’ve seen those eyes all too often here on Kauai, where an untold number of people are soul dead due to their addition to ice, alcohol, heroin, prescription drugs or some combination thereof.

Their addictions, like Aureo’s, often lead to other crimes. His father acknowledged that Aureo sold some of the oxycodone that doctors prescribed, which is a relatively common occurrence, and he was robbed of his recently-filled prescriptions for some 150 oxycodone and 50 morphine tablets, which is another common occurrence, although having it happen at gunpoint in the Safeway parking lot, with a shot fired, is not. Ultimately, his addiction led to his murder, though the motivations and circumstances for that crime remain to be proven in the first-degree murder trial of Vicente Hilario.

Because addictions often are linked to crimes, and because some of the addictive substances are illegal, police and members of the public like to treat it as a law enforcement issue. They focus on busting people who are selling and using, which results in an unending stream of addicts moving through the judicial system. All too often, because of their addiction and criminal history, they end up impoverished and homeless, which exacerbates their addiction and leads to more crime.

And so the cycle continues. Meanwhile, the public gets frightened and demands longer jail terms and more cops on the beat, and the police and judiciary get frustrated by the revolving door clientele and take an even more punitive approach, and everyone loses their compassion and starts talking about locking these people up and throwing away the key because they’re not getting any better, you know, and the problems they’re creating for society, are getting worse.

We’ve been doing it like this for quite a while now, and we haven’t made any real headway in reducing either addiction or the associated crime. But we have filled up the prisons and clogged the court system and destroyed numerous families and flushed a lot of lives down the toilet.

Do you suppose we could try a different approach, one that starts by taking a fundamentally different view of addiction? Do you suppose we could stop treating addiction as some shameful weakness or moral failure, or even a disease? Do you suppose we could actually begin looking at the root cause, and attempt to address it there?

Over the holidays, I listened to a series of Democracy Now interviews with Dr. Gabor Maté, a Vancouver physician and author who has worked extensively with addicts, and so has come to gain a deep understanding of what led them down that path. His compelling observations had a profound affect on me:

The hardcore drug addicts that I treat, but according to all studies in the States, as well, are, without exception, people who have had extraordinarily difficult lives. And the commonality is childhood abuse. In other words, these people all enter life under extremely adverse circumstances. Not only did they not get what they need for healthy development, they actually got negative circumstances of neglect. I don’t have a single female patient in the Downtown Eastside who wasn’t sexually abused, for example, as were many of the men, or abused, neglected and abandoned serially, over and over again.

And that’s what sets up the brain biology of addiction. In other words, the addiction is related both psychologically, in terms of emotional pain relief, and neurobiological development to early adversity.

Maté then went on to talk about the biology of addiction:

You see, if you look at the brain circuits involved in addiction—and that’s true whether it’s a shopping addiction like mine or an addiction to opiates like the heroin addict—we’re looking for endorphins in our brains. Endorphins are the brain’s feel good, reward, pleasure and pain relief chemicals. They also happen to be the love chemicals that connect us to the universe and to one another.

Now, that circuitry in addicts doesn’t function very well, as the circuitry of incentive and motivation, which involves the chemical dopamine, also doesn’t function very well. Stimulant drugs like cocaine and crystal meth, nicotine and caffeine, all elevate dopamine levels in the brain, as does sexual acting out, as does extreme sports, as does workaholism and so on.
Now, the issue is, why do these circuits not work so well in some people, because the drugs in themselves are not surprisingly addictive. And what I mean by that is, is that most people who try most drugs never become addicted to them. And so, there has to be susceptibility there. And the susceptible people are the ones with these impaired brain circuits, and the impairment is caused by early adversity, rather than by genetics.

When people are mistreated, stressed or abused, their brains don’t develop the way they ought to. It’s that simple. And unfortunately, my profession, the medical profession, puts all the emphasis on genetics rather than on the environment, which, of course, is a simple explanation. It also takes everybody off the hook.

[I]f people’s behaviors and dysfunctions are regulated, controlled and determined by genes, we don’t have to look at child welfare policies, we don’t have to look at the kind of support that we give to pregnant women, we don’t have to look at the kind of non-support that we give to families, so that, you know, most children in North America now have to be away from their parents from an early age on because of economic considerations. And especially in the States, because of the welfare laws, women are forced to go find low-paying jobs far away from home, often single women, and not see their kids for most of the day. Under those conditions, kids’ brains don’t develop the way they need to.

And so, if it’s all caused by genetics, we don’t have to look at those social policies; we don’t have to look at our politics that disadvantage certain minority groups, so cause them more stress, cause them more pain, in other words, more predisposition for addictions; we don’t have to look at economic inequalities. If it’s all genes, it’s all—we’re all innocent, and society doesn’t have to take a hard look at its own attitudes and policies.

His comments about the current approach to addiction — criminalization — were especially poignant:

[I]f people who become severe addicts, as shown by all the studies, were for the most part abused children, then we realize that the war on drugs is actually waged against people that were abused from the moment they were born, or from an early age on. In other words, we’re punishing people for having been abused. That’s the first point.
The second point is, is that the research clearly shows that the biggest driver of addictive relapse and addictive behavior is actually stress. [S]tress drives addiction.

Now imagine a situation where we’re trying to figure out how to help addicts. Would we come up with a system that stresses them to the max? Who would design a system that ostracizes, marginalizes, impoverishes and ensures the disease of the addict, and hope, through that system, to rehabilitate large numbers? It can’t be done. In other words, the so-called “war on drugs,” which, as the new drug czar points out, is a war on people, actually entrenches addiction deeply. Furthermore, it institutionalizes people in facilities where the care is very—there’s no care. We call it a “correctional” system, but it doesn’t correct anything. It’s a punitive system. So people suffer more, and then they come out, and of course they’re more entrenched in their addiction than they were when they went in.

As Albert Einstein reportedly said, the definition of insanity is doing the same thing over and over, and expecting different results.

Using that definition, it’s clear that our current approach to addiction is sheer and utter madness. So do you suppose we could try something different? Something that gets to the root of the matter? Something that actually prevents addiction, and helps the addicts? Because they are, after all, our children, our parents, our sibings, our spouses — maybe even ourselves.


Anonymous said...

Mahalo Joan!
I too have been reflecting on Gabor Mate's interview. Would you consider writing a guest viewpoint for the GI? Regardless of how good or bad the publication, the community at large could benefit from this perspective shared.

Anonymous said...

I also listened to the show you referenced in your blog this morning. It was spell binding in it's logic and truth. Most of my close friends are dead now, the victims of drugs and alcohol all of them had really tough early lives.
Until the system changes it's going to be more of the same. I don't blame capitalism but I do blame consummerism which is not the same thing as capitalism. I also think that people today would feel cheated if they had to stay at home and take care of the kids. Almost everyone has bought into the big con.

Anonymous said...

What is the quintessential source(s) of why people take drugs like alcohol, pain killers, and other mind numbing drugs (legal or not)?

What is the underlying reasons...others take stimulants like Ice and Coke?

We have family, social and community problems.

Locking people up does not solve the problem, although if we do lock up violent crimes people....they might prevent someone else from getting hurt.
More money for cops, guns and prisons = Prison Planet?

People who drive drunk are committing a violent crime too....or have the intention of doing so. We should probably lock them up too.

But nothing will change unless we put money and effort where it will make the biggest differences, i.e. "treatment" of personal problems that lead to addictions: rehabilitation from drugs, job training (trades), family counseling, individual counseling.

I have an ex-con / violent / druggie living next door now. No job, poor grammar, no skills, lives on SSI, and no hope.

Dr Shibai

Anonymous said...

How can we as a society correct the abusive behavior of the illiterate and lost while at the same time we lionize the same types when they somehow achieve super star status in sports (read surf stars).

Anonymous said...

Interesting was his comments about the cause of ADD something he was diagnosed as having and attributed to the loss of the tribe and parents who are stressed and unavailable for their children. Many growing up as latch key kids.