VICE: You're critical of the rehab industry because, according to you, it pulls addicts in under the ruse of medical treatment. However, it offers little more than 12 steps and pep talks. You've called it a canard. Can you elaborate?
...I'm criticizing the way the medical model is used both to conceptualize addiction and to underpin, support, and reinforce the philosophy of the rehab industry. Because it fails people so often, the medical model and definition of addiction should be seriously challenged, but it isn't and there's something really wrong with that. It's a self-reinforcing system that waves this banner that says you have a chronic disease that will kill you, so you better come to us. The rationale that they have a disease has a lot of weight, especially because it's backed up by a lot of high-level bodies, like NIDA (National Institute on Drug Abuse). NIDA funds about 90 percent of addiction research in the world, according to some reports. You're giving money to people who are doing research on the biological or cellular mechanisms involved in addiction, but they're not giving money to people who are challenging the disease model, so that in itself is a self-perpetuating system. In other words, medicine does not have much to offer addicts? Does that mean treatment is really a testament of will? Will has an awful lot to do with it. A lot of addiction experts feel that self-empowerment, self-motivation, self-directed activities, self-designed goals for [addicts'] own progress are critical steps on the road of overcoming addiction. The medical model says you're a patient and you have to do what the doctor tells you.
[Del. Dan Morhaim, a doctor and Maryland legislator] is quoted as saying addiction is "a medical issue that has disastrous social consequences." That's very typical. Take those words, turn them around and you have something that's much more accurate: It's a social issue that has disastrous medical consequences. Throwing people in jail and prohibition are responsible for a lot of the harm that comes with addiction. The prohibitions create this narrow passageway by which addicts have to squeeze themselves through, which drives them into crime, which breathes life into criminal organizations and cartels that get rich on the war on drugs...
...defining addicts as patients makes them passive. It makes them fatalistic and it makes them pessimistic. If you're told you have a chronic brain disease that causes you to do all this nasty shit, you don't think you'll ever get free of it. But, in fact, most addicts do recover and the statistics are very clear on that, whether they're soft drugs or harder drugs like heroin. So, it's a chronic disease? Really? The second thing is it tends to overshadow other approaches to treating addiction that relies on much more individualized psychological methods. There are various kinds of psychotherapy, counseling, support networks, and mindfulness meditation approaches that are also being shown to be very effective. If you believe you have a chronic disease and so does your care provider, they're not very likely to recommend mindfulness meditation, but it's been shown to be very effective...
While opiate and alcohol withdrawal can wreak physical havoc on addicts, you argue that addiction is purely behavioral rather than physiological, like, say, cancer is?
That's another discrepancy. You have substance addiction on one hand, and behavioral on the other: gambling, sex addiction, porn addiction, a number of eating disorders, internet gaming. The cool thing is when you do brain scans, you get the same neural activation patterns in behavioral addictions as you do in substance addictions. That should be enough to knock out the disease model. If addiction is a disease, then people who spend 12 hours a day playing video games are suffering the same way people who are addicted to heroin do...
What all these patterns have in common is they involve deep learning—a set of assumptions of what you need to get through the day; that learning gets entrenched through repetition and you're addicted, but there's nothing disease-like about it. People recover from all addictions, which means it's all about neural plasticity. It's not that you go back to where you were, because development never goes in reverse, it's that you learn skills that help you overcome your impulses and you learn new cognitive habits. All learning involves changes in synapses, which means creation and strengthening of certain synapses, and the weakening or disappearance of synapses that aren't being used...
I've talked to Nora Volkow, [the director] of NIDA and a very powerful policy maker. She doesn't want to hear it. She's basically saying that addicts need to be told they have chronic brain disease because that will reduce stigmatization. But people like me come along and say, "No, it doesn't look like brain disease. Brain change, yes. But that's what a brain is supposed to do because it's learning." That's when the wall comes down."
"If addiction is not a disease, does that render the "alcohol gene" a fallacy?
You get little things that show some genetic correlation with alcoholism, but there is no gene, or cluster of genes, that create addiction. Rather, there are personality traits that have a genetic loading, like impulsivity. So you get these cross-generational correlations that are real and do have genetic loading, but there's nothing like a particular gene or set of genes specific to addiction...
In layman's terms, what is addiction if it isn't a disease?
Addiction is learning, very simply. It's learning a habit of thinking. It's deeply entrenched learning. So are relationships when you're in love with someone. If that person happens to be abusive, you might still be in love with them for 12 years or the rest of your life. That's through learning. So is being a sports fan or a Jihadist. Religion is another deep substantiation of deep learning. That's what I think it is. The fact that it could be gambling, or eating, or heroin, or meth, it shows there are certain addictions that involve substances that create physical dependency. Physical dependency is a whole other layer of shittiness on top of addiction. Psychological and interpersonal tools are very important. Addiction has to do with isolation and feeling alone, not having a support network and not being able to deeply connect with other people. You can superficially connect and have a nice circle of addicts, but not connecting with people in a way that's harmonious and fulfilling, those are the people that are really vulnerable to addiction. They're lonely, depressed, anxious, and traumatized. It's just like the Rat Park [Canadian study into drug addiction]. What I said doesn't just apply to humans, it applies to other animals, too. Isolation is really bad for you and it's the underlining factor of addiction."
