Unbroken Brain: A Revolutionary New Way of Understanding Addiction

by Maia Szalavitz

A NEW YORK TIMES BESTSELLERMore people than ever before see themselves as addicted to, or recovering from, addiction, whether it be alcohol or drugs, prescription meds, sex, gambling, porn, or the internet. But despite the unprecedented attention, our understanding of addiction is trapped in unfounded 20th century ideas, addiction as a crime or as brain disease, and in equally outdated treatment. Challenging both the idea of the addict's "broken brain" and the notion of a simple "addictive personality," The New York Times Bestseller, Unbroken Brain, offers a radical and groundbreaking new perspective, arguing that addictions are learning disorders and shows how seeing the condition this way can untangle our current debates over treatment, prevention and policy. Like autistic traits, addictive behaviors fall on a spectrum -- and they can be a normal response to an extreme situation. By illustrating what addiction is, and is not, the book illustrates how timing, history, family, peers, culture and chemicals come together to create both illness and recovery- and why there is no "addictive personality" or single treatment that works for all.Combining Maia Szalavitz's personal story with a distillation of more than 25 years of science and research,Unbroken Brain provides a paradigm-shifting approach to thinking about addiction.Her writings on radical addiction therapies have been featured in The Washington Post, Vice Magazine, The Wall Street Journal, and The New York Times, in addition to multiple other publications. She has been interviewed about her book on many radio shows including Fresh Air with Terry Gross and The Brian Lehrer show.

Genres: Nonfiction, Addiction, Psychology, Science, Self Help, Mental Health, Memoir

349 pages, Kindle Edition

First published March 22, 2016

About the author

Maia Szalavitz is an award-winning author and journalist who covers addiction and neuroscience. Her next book, Unbroken Brain (St. Martins, April, 2016), uses her own story of recovery from heroin and cocaine addiction to explore how reframing addiction as a developmental disorder could revolutionize prevention, treatment and policy.

She's the author or co-author of six previous books, including the bestselling The Boy Who Was Raised as a Dog (Basic, 2007) and Born for Love: Why Empathy Is Essential-- and Endangered (Morrow, 2010), both with leading child psychiatrist and trauma expert Bruce D. Perry, MD, PhD.

Her book, Help at Any Cost: How the Troubled-Teen Industry Cons Parents and Hurts Kids, is the first history of systemic abuse in "tough love" programs and rehabs and helped spur Congressional hearings, GAO investigations and proposed legislation to regulate these groups. She also co-wrote the first evidence-based consumer guide to addiction treatment, Recovery Options: The Complete Guide, with Joe Volpicelli, MD, PhD. (Wiley, 2000).

Currently, she writes a bi-weekly column for VICE on drugs and addiction. From 2010 to 2013, she wrote daily for TIME.com and she continues to freelance there and for other publications including the New York Times, Scientific American Mind, Nature, New York Magazine online, Pacific Standard, Matter, Nautilus, and The Verge.

Szalavitz has won major awards from organizations like the American Psychological Association, the Drug Policy Alliance and the American College of Neuropsychopharmacology in recognition of her work in these areas.

She lives in New York with her husband and a Siamese shelter cat.

Reviews

[Julie · Rating 5 out of 5]

... addiction is not a sin or a choice. But it's not a chronic, progressive brain disease like Alzheimer's either. Instead, addiction is developmental disorder—a problem involving timing and learning, more similar to autism, attention deficit hyperactivity disorder (ADHD), and dyslexia than it is to mumps or cancer.

The phone rang during a station identification break. Caller ID was enough. I answered, saying, "I know. I'm listening. My mind is blown." It was early July and journalist-advocate Maia Szalavitz was being interviewed by Terry Gross on WHYY's Fresh Air. The next day I went to my local bookstore to order Unbroken Brain. It was backordered. Weeks. When it finally did arrive last week, I carved out time each afternoon to read, writing notes in my journal, in the book, sharing the parts that made me gasp or tear up with my partner, who has struggled with addiction since pre-adolescence.

The theories Szalavitz's posits in Unbroken Brain (and to those reviewers who criticize her lack of empirical data and research citations, you apparently missed the THIRTY-FOUR pages of Notes in the index, printed in 6-point font) are the result of thirty years spent researching and writing about addiction. Woven into this distillation of addiction and treatment is the author's own experience with heroin and cocaine abuse as a young woman in the 1980s that nearly ended her life more than once.

Unbroken Brain is an examination and take-down of current theories and approaches to addiction, from the lack of moral fiber and addictive personality character disorder that is at the heart of the 12-step program treatment approach (which decades of research has debunked—there is no "addictive personality" type) to the notion that addiction is a disease like cancer over which the person with addiction has no choice or control. And regardless of our supposed empathy for the "victims" of a disease, we—as family members, partners, and a legislative and judicial system—regard substance abuse as a sin and criminalize the behaviors, punishing the person instead of providing treatment. What we do know is that it is possible to identify children at risk of developing self-destructive habits and intervene with positive coping mechanisms at an early age, providing individuals with learning tools long before "rehab" becomes necessary.

By accepting addictive behaviors as development disabilities and learning disorders, Szalavitz (and really, the neuroscientists, psychologists, addiction therapists, social psychologists, and psychiatrists behind the research she presents), demonstrates how we can begin to focus on the causes, not the symptoms. We can advocate for humane, empathetic treatment that will allow people with addiction to find new ways to cope, replacing destructive addictions with healthy behaviors. Addiction is learned behavior and can be unlearned.

Addiction is a result of complex genetic, environmental and developmental factors and therefore there is no one-size-fits-all approach to treatment, but Szalavitz makes a strong and data-supported case for Cognitive Behavioral Therapy, as well as the HARM reduction methods used to keep addicts safe from HIV and AIDS by providing sterile needles, the decriminalization of drug use—which places an emphasis on treatment instead of punishment—and using 12-step methods as support but not treatment, as has been the default for decades. She also details what enabling is, and what it isn't, and shows that tough love and punishment only serve to tear down what few reserves people with addiction have. Compassion, consistency, love, and support work in service of behavioral change. Threats and ultimatums and shame do not.

Unbroken Brain goes broad and deep into all aspects of addiction, from causes to treatment, from neuroscience that includes epigenetics and neurodiversity, to the very political nature of the American criminalization of addiction, which is fueled by Jim Crow racism and social stigma. Yet Szalavitz writes in an inclusive, generous, conversational style, threading her own narrative in with each chapter. Her life becomes the beacon we follow to ground us in this journey of new understanding.

“With addiction, the vast majority of people do recover,” Szalavitz says. “And that’s a really important thing for people to realize. The reason I called the book Unbroken Brain is that your brain isn’t broken. You’ve learned something that is problematic.”

Highly recommended for anyone who deals with addiction or has a person with addiction or an associated mental disorder such as depression, obsessive-compulsion, manic-depression, or a learning disorder in their lives. I found it to be a release from despair and a source of hope.

[Dean · Rating 5 out of 5]

As a recovery advocate and the father of someone in long-term recovery, I've read more books about addiction than I can count. When my son first started struggling with drugs, I made a vow to educate myself as much as I possibly could. Knowledge is power, and I wanted to know everything about addiction. I still do. So I read about it. A lot. And I can honestly say that Maia Szalavitz's Unbroken Brain: A Revolutionary New Way of Understanding Addiction is one of the best books I've ever read on the subject.

Maia Szalavitz is a fabulous writer who has penned a wonderful, very forward-thinking book about addiction. She introduces us to some new theories about addiction, several of which may have people re-examining the way they've thought about one of the most prevalent and deadliest problems in America today.

Szalavitz sets out to show that addiction isn’t a choice or moral failing. "But it’s not a chronic, progressive brain disease like Alzheimer's, either," she notes. “Instead, addiction is a developmental disorder--a problem involving timing and learning, more similar to autism, attention deficit hyperactivity disorder (ADHD), and dyslexia than it is to mumps or cancer." Yes, Szalavitz is blazing new trails here.

The author contends that "addiction doesn't just happen to people because they come across a particular chemical and begin taking it regularly. It is learned and has a history rooted in their individual, social, and cultural development." She adds that the addicted brain is not "broken," as many other researchers and writers have suggested. Instead, she says, the addicted brain has "simply undergone a different course of development....addiction is what you might call a wiring difference, not necessarily a destruction of tissue."

Looking at addiction as a learning disorder may seem strange to some, but Szalavitz states that doing so "allows us to answer many previously perplexing questions." And in Unbroken Brain, Szalavitz--who is 25+ years in recovery from cocaine and heroin addiction herself--tells us how learning is a part of every aspect of addiction, oftentimes drawing upon her personal experience to illustrate her points.

There are so many interesting and thought-provoking topics covered in this book. From the problems associated with waiting for someone to hit "rock bottom" to the myth of the addictive personality; and from the issues surrounding 12-step programs to why harm reduction isn't a bad thing. ("Harm reduction recognizes [the] social and learned components of addiction. It 'meets people where they're at,' and it teaches them how to improve their lives, whether or not they want to become abstinent." Amen to that.)

If you or someone you love has been touched by addiction, or if you're just interested in this fascinating subject, I cannot recommend Unbroken Brain highly enough. This book contains a wealth of information, but Maia Szalavitz presents it in an organized manner while writing in a clear and understandable voice. Trust me: You will not be bombarded with a bunch of scientific language that you don't understand.

Szalavitz writes in the introduction, "Only by learning what addiction is--and is not--can we begin to find better ways of overcoming it. And only by understanding addicted people as individuals and treating them with compassion can we learn better and far more effective ways to reduce the harm associated with drugs." That is definitely the approach we should be taking with addiction. Hopefully, Maia Szalavitz's innovative new book will be the catalyst for some positive change.

[Kony · Rating 3 out of 5]

I learned a thing or two from this book, but I'd hesitate to recommend it.

I do believe it adds value to our public discourse about addiction. Ms Szalavitz describes her own addiction and recovery with clarity and insight. She paints a mostly accurate picture of the blind spots and pitfalls of our punitive drug policies. She offers a constructive critique of our society's overreliance on 12-step programs. She sheds light on neurological insights that can help us better understand, prevent, and address addiction.

That said, this book gives me pause for a few reasons:

* The author's central thesis is that addiction is a "learning disorder," and that we should start treating it as such. I agree that addiction impacts learning processes, and that addictive behaviors are learned, but I don't agree that addiction is therefore equivalent to a "learning disorder." The logic behind this claim is fuzzy, and it could lead to conflating several different mental-health / cognitive-development issues that are really not the same.

* Ditto for the author's corollary claim that addiction is a "developmental disorder." Possibly true in her case, but not for everyone. Indeed, in critiquing 12-step programs, she aptly notes the pitfalls of entrusting one's recovery to non-professionals whose sole qualification is their own personal experience with addiction. Yet ironically, in this book she - a journalist, not a doctor - presents her own personal experience as a lens through which we might better understand addiction writ large.

* In her laudable attempt to humanize people with addictions, she throws other stigmatized groups under the bus. I'm talking about people who have been convicted of violent crimes, whom she treats as an undifferentiated group, suggesting they're more likely to be sociopathic and deserving of harsh punishment. I'd strongly encourage her to step back and consider violent behavior from the same neurological perspective that has informed her nuanced, compassionate approach to addictive behavior.

* If she's hoping to reach a broad audience, perhaps she could be more balanced in engaging other viewpoints. She presents the issues as either-or: "either we treat addiction as a learning disorder, or we continue to engage in senseless punishment." This is a rather preachy approach, and it forecloses constructive dialogue with those who are open to new ideas but find her argument less than airtight.

I'd recommend listening to the author's interview on Fresh Air with Terry Gross - it imparts her story and position in an engaging way. But if you're looking for a truly informative and well written book on these issues, read In the Realm of Hungry Ghosts by Gabor Maté.

[Keith Wilson · Rating 5 out of 5]

Because I'm a substance abuse counselor, people have often asked me to recommend a book about addiction. For thirty years, the only one I ever urged people to read has been the Big Book of AA, written eighty years ago, when we knew next to nothing about addiction. I’ll get into the reason why I recommended it in a minute. I’m happy to say that now there’s a better book for anyone interested in learning about addiction, drawing on the latest findings, written by an award winning journalist and recovering addict, Maia Szalavitz. Her book is Unbroken Brain.

The central premise to Unbroken Brain, is that we’re in the middle of an epidemic of addiction and we are stuck in treating it ineffectively when there are better methods available. One in ten Americans are in the throes of some type of substance use disorder. That’s 23 million and doesn’t even count tobacco addiction and the myriad millions who have behavioral addictions to sex, gambling, shopping, etc; nor, one third of Americans who overeat and are said to be addicted to food. At the same time, pharmaceutical companies, tobacco companies, alcohol companies, agribusiness companies, casinos, lotteries, and every store at the mall all seem to know how to induce addiction for their purposes. We need some new ideas to help people, or, at least, stop recycling old ideas that don’t work.

The first idea that doesn’t work is throwing addicts in jail. Think about it; addiction is defined as using, despite negative consequences. Why then would we believe that applying negative consequences would treat addiction? It makes no sense, but we do it anyway.

I’ll tell you why we do it. AA taught us to. Yes, the Big Book of AA, that other book I told you about, the only one I ever could recommend, has taught us that addicts have to hit bottom, they have to lose everything and become totally humiliated before they will ever change. It’s this idea which justifies the drug war, mass incarceration of addicts, and many of the other degrading things we put addicts and their families through.

This is where I give you the reason I have never been able to recommend any book other than the Big Book of AA. It’s because the field of addiction has been so dominated by it, that no one has been able to go further, or contradict, the ideas found there. Almost everything else that has been written about addiction is based on AA principles.

When I began working in the addictions field, practically everyone else working as a counselor was a recovering addict. AA had saved their lives. They were consequently devoted to AA and, when they wrote books and designed what were supposed to be professional treatment programs based on science and best practices, they just repeated AA slogans and principles. That’s fine as long as AA works, but frequently it doesn’t work; actually, more often than not, it doesn’t. seventy percent of the people who try AA-like groups drop out within six months.

If a doctor had a pill that 70% of her patients stopped taking before the course of treatment was complete, she’d conclude that the pill had serious side effects, instead of just blaming the patients for being uncooperative. In addiction treatment we blame the patients. We say they haven’t hit bottom yet. They have to hit bottom before they will get serious.

I didn't enter the addictions field by first being in recovery. I entered it because I wanted to be a counselor and saw opportunities there. When I began, I found that the counselors were treating clients very differently than they way I was taught to treat them in school. I was taught to respect clients, offer them unconditional positive regard, and put them in the driver’s seat. What I saw was the opposite. Chemical dependency counselors were very directive; they told people when and how they were full of shit, and made decisions for them. They said a client’s best thinking got them in this mess; it was not able to get them out. They said that an addict is lying whenever his lips are moving. When I objected, I was told things had to be different in chemical dependency. Addicts would take advance of my naiveté. My education had not prepared me for the real world. An addict’s mind was broken, they said, we can’t expect it to work like everyone else’s.

According to Szalavitz, they’re wrong and I should have believed what I was taught in school all along. Addiction does not break a brain, nor is it caused by a broken one. She characterizes addiction as a developmental disorder, like autism, ADHD, or dyslexia; which arises as an attempt to solve problems like trauma, interpersonal conflict, and sensitivity to stimulation, for which the person’s brain is not yet equipped; and one which resolves itself if the person is given the opportunity to learn from their mistakes. Indeed, the vast majority of addictions begin in adolescence and most end by the time the brain is mature around age thirty.

If we treated others who have a developmental disorder as we do addicts, we would tell the kid with dyslexia, for instance, that nobody could help him until he came to the realization that he was powerless over his dyslexia. We would punish him whenever he spelled a word wrong and, if he continued to do so, would throw him out of school, and maybe into jail. Not only would we fail to teach him, but we would call anyone else who had patience for him codependent and enabling. That’s not what we do with dyslexics, not any more, anyway; consequently, most compensate for their dyslexia and learn to read.

The concept of hitting bottom undermines AA’s other, more accurate, principle that addiction is a disease. It justifies the criminalization, discrimination, and humiliation of addicts. It spawns “tough love” approaches and the pathologizing of loved ones as codependent. It led to abusive methods in many other “therapeutic communities.” It leads to seventy percent of the people walking out.

There are many more points Szalavitz makes in this quite comprehensive book about addiction. She reviews in detail the connection between our drug policies and racism. She gives us the the dope on dopamine. She describes the twin hooks of wanting and having. She gets autobiographical, revealing her own transit into and out of addiction. But, for me, it is the counterpoint she provides to the last great book about addiction that is most valuable. Read Unbroken Brain if you need to understand something about addiction.

Keith Wilson writes on mental health and relationship issues on his blog, Madness 101

[Emily · Rating 4 out of 5]

I took a long break from this book after getting to chapter 9 and her repeated mentions to her first experience with cocaine being with Jerry Garcia. I was extremely (maybe to the extent of going a bit overboard) vexed by what I perceived as name-dropping and bragging in conjunction with drug use. At the time, I probably needed a target for some anger, and this was an easy one.
I am glad I went back to reading this. It has insights into addiction that I found personally helpful. I can truthfully say the insights were life-changing, and hope that doesn't sound too effusive.
Her points are repeated throughout the book. If you wanted the gist of what she's saying, without all the references to studies, anecdotal support, and her own story, you can get a decent idea by reading chapter 20: Neurodiversity and the Future of Addiction.
But I never could wrap my brain around her terminology that addiction is a "learning disorder." I could pick up what she was laying down as far as it being learned behavior, based on environmental and psychological factors, and an unpredictable pattern of use and reward. I just didn't see how that makes it a disorder. What was most valuable to me was what she had to say about treatment methods and societal attitudes toward addicts.

"Understanding addiction as a learning disorder means creating individualized approaches to address it--on the biological, psychological, social, and cultural levels. It means using models that view participants as students who need to be empowered by education--not defective people who can't make good choices unless they are forced to and who need to be humbled and then indoctrinated."

And I really liked what she said about anti-drug programs in schools needing to focus on teaching kids positive coping skills, rather than the "Drugs are bad, mmmkay?" approach and scare tactics, which will scare some and intrigue others.
I knocked the rating down a star because her writing style bothered me at times (64 instances of the word "indeed," for example), the memoir segments were not as interesting to me as the neuroscience, studies and experimental programs she discussed, and her citation method was my least favorite type (not numbered, just piled up in the back with the opening sentence the reference point).
Those minor quibbles aside, I highly recommend this book, especially for friends and families of addicts.

[Scott · Rating 2 out of 5]

While I enjoyed her personal anecdotes, the lack of citations supporting her assertions leads me to consider this a memoir and not a revolutionary new way of understanding addiction.

[Carla · Rating 5 out of 5]

My review for The Associated Press:

Nancy Reagan's death last month caused some to take stock of her mantra "Just Say No" and why it failed to prevent addiction or dissuade many young people in the 1980s from experimenting with dangerous drugs.

In "Unbroken Brain," science writer Maia Szalavitz, a high school student in the Reagan years, describes her own drug odyssey — LSD, cocaine, heroin — and her first steps toward successful recovery at age 23 in 1988. Since then, understanding addiction and treatment has been her life's work. She's now regarded as a leading authority, with articles in Time, The New York Times, Psychology Today and other major publications.

Her previous book, "Help at Any Cost," examined programs for troubled teens. This time, she argues for a radical rethinking of addiction with a new emphasis on learning.

She writes that although addiction is a disease, a more nuanced analysis reveals it to be a learning disorder, more like dyslexia than diabetes, opening new possibilities for treatment, recovery and drug policy. This learning disorder framework takes into account genetic vulnerabilities, brain development and experience, she says, and helps explain why locking up addicted offenders largely fails to rehabilitate them.

Addiction is a pattern of learned behavior defined by persistence despite negative consequences, she writes, and that is why punishment — because prison, after all, is just one more negative consequence — doesn't work and can be counterproductive.

Szalavitz finds some value in the Alcoholics Anonymous self-help movement, but objects to its elevated status in medical and criminal justice systems. In what other disease, she asks, would medical professionals recommend submission to a Higher Power as an essential part of treatment? A chapter on programs employing the learning disorder insight offers another way.

Szalavitz's personal story complements her research without overshadowing it, including an unforgettable scene in which she does cocaine with Jerry Garcia of the Grateful Dead. She writes movingly about the mental and emotional consequences of drug withdrawal, far worse than the physical symptoms, in her experience: " ... what tormented me most as I shook through August of 1988 wasn't the nausea and chills but the recurring fear that I'd never have lasting comfort or joy again."

Anyone who has battled addiction or seen it harm a loved one will gain insights from "Unbroken Brain," and if it influences policymakers, too, everyone will benefit.

[Tim · Rating 5 out of 5]

I've hard far too much proximity to addiction from struggles in my own life to friends to the overdose death of my ex-wife. This is the most profound, truthful, relatable way of thinking about the topic that I've seen. AA never sold me. I get the support that a community can provide but the degrading of the self and ego that's seen in a lot of AA methodology never seemed completely healthy. The ideas here are empowering, they're positive and encouraging and give a sense of agency back to the addict. We've learned improper coping methods and the brain can be re-programmed through different forms of therapy and healthy ways of coping. Another book that speaks of similar focuses is called The Heart of Addiction by Lance Dodes - also recommended as an alternative to 12-step ideas.

The other focus of this book is a brutal dismantling of our completely inept American drug policies and how much we as Americans have affected drug policy in the rest of the world. In fact, the book is almost a two-part study: What addiction actually is and how our drug policies are completely inappropriate. Both issues of course are extremely complex and the motivations for our drug policies are obviously deeper than a simple misunderstanding of what constitutes addiction. Racism, economics, global politics and power all play into it. But for me, the most rewarding part of this book was the insights into human motivations and coping methods - why we chose to engage in the activities that we do. Hope can be hard to come by when dealing with addiction but maybe you can find some here.

[Cym & Her Books 🍉 · Rating 5 out of 5]

An outstanding book from my workplace staff library! I work in a rapid access to addictions medicine clinic that specializes in opioid agonist therapy (i.e. methadone, suboxone, etc.) so this book was completely fascinating, especially when considering the clients I work with. Rephrasing addiction as a learning disorder as opposed to a medical or moral condition made a great deal of sense when thinking about how/why people become addicted to a substance, as opposed to just using it recreationally or otherwise. Addiction doesn't happen the first time you take something, but after repeatedly trying it and finding that it helps you with a, b, or c.
I appreciate that Szalavitz told her story alongside the evidence she presented. I appreciate that she acknowledges her privilege when recounting her involvement with the justice system. I super appreciate the chapter on harm reduction <3
5 stars, amazing read! Would recommend wholeheartedly.

[Camille McCarthy · Rating 5 out of 5]

This was an excellently-written book on addiction. It is part memoir as well, since the author uses her own experiences growing up as a neuro-divergent person and her experiences with heroin and cocaine addiction to outline the book. She delivers a detailed critique of the twelve-step programs and how they are used in professional therapy settings, as well as the criminal justice response to addiction, the attitude towards those who are addicted, and the difficulties of being differently wired and how that can lead to problems with addiction. It was a very personal book and her humility shines through. Also, she is clearly very knowledgeable about the psychology behind addiction from an academic standpoint, so the book is a mix of academic language and personal memoir.
The book was published in 2016 and even in five years I feel like we have progressed substantially in the attitude towards addiction and drugs. Decriminalization is making great strides in many states and in many countries. Marijuana legalization is becoming more widespread. Baltimore just announced that they will not arrest people for minor drug offenses. Harm reduction is becoming a well-known concept. I credit Szalavitz for using her own experiences and knowledge to further change attitudes about addictions and I am sure her work has been a part of the large changes in attitudes.
I wish she had gone into what certain alternatives to the 12-step programs actually entail. She described them (LEAD and ARRIVE) but I still can't tell what actually happens at a meeting, for example, whereas most of us are familiar with 12-step program meetings.
The book went a bit slowly for me because there is a lot of background information and I think she purposely made it very academic so that it doesn't read like a drug memoir that would make drugs seem tempting, such as a William Burroughs book. I thought it was effective, since after reading this I have no desire to try drugs and what I took away was that there are much better coping mechanisms for issues people face and if they learn those instead, they will likely not become addicted to drugs. I would like to know more about these other coping mechanisms but that seemed to be beyond the scope of this book.
I would definitely recommend this book as it explains addiction in a deeply compassionate and data-based way, is well-written, and covers the topic thoroughly.

[Dianne J. · Rating 1 out of 5]

This books was long and detailed with a drug addicts' recollections of childhood and beyond; creating a long list of not so perfect incidences that led to her addiction.

Frankly, I lost interest in the story and was troubled by the enormous lack of footnoting. For instance making the following claims as fact needs a lot of footnoting to corroborate the information:
"Surprisingly, only 10-20% of those who even try the most stigmatized drugs like heroin, crack, and methamphetamine become addicted[page 21]" and "In fact, 90% of all substance addictions start in adolescence, and most illegal drug addictions end by age 30 [page 20]" should be accompanied with footnotes from reputable sources.

Chapter 2, [page 58] The History of Addiction: "Some archaeologists even claim that civilization itself began when humans settled down to grow grain-not because they wanted it for food, but to make beer." Really?

Finally, I am intrigued with Szalavitz's hypothesis that addiction is a learning disorder. However, I have read enough to know that addiction is an illness and even though society sees addiction as a moral failing and punishable with a prison sentence overall I believe that in time, with more awareness to addictive disorders drug addiction will be seen for what it is; an illness not a moral failing or a crime.

[Prettytaz83 · Rating 3 out of 5]

I'm stuck on my rating for this book. I wanted to give it a higher rating, and I like a lot of the theories and explanations here.

However, there are a lot of opposing views in the material itself ("it's a learning disorder.... Well... Except for when it changes the brain". Which, if it does that, means it can't solely be a learning disorder, as one example).

I also think the sections on marijuana and criminal justice were clearly very one-sided, and didn't highlight any of the potential concerns. It's clear the author didn't seem to see any downsides to marijuana use. A lot of criminal justice is being very progressive --- using MRT treatment, motivational enhancement training, CBT, and client-directed case planning tools to aid in the change process. But you wouldn't know any of that. It's very, "it shouldn't be criminalized at all", and anything short of that is doing irreparable harm....

I thought it a great idea, but some of the constant reductive ideas about addiction and addictions theory were extremely frustrating to get through.

[Sara · Rating 4 out of 5]

This book discusses some very interesting and eye-opening aspects of addiction, neurochemistry, and learning/environment. I found myself, at several points in the reading, listing the people in my life I think would be intrigued by the connections and observations Maia has made. I think it's a great book, and will likely buy it just so I can loan it out and refer to it later.

While Szalavitz may be making claims about the nature of addiction that are new or counter to what most believe, it distills down to something very simple, and actually quite obvious when you think about it. She says addiction is a learned phenomenon that involves _persisting in a compulsive behavior despite negative consequences_. Whether it's the threat of loss of job/friends/home, jail, or death, the compulsion persists. This is why punitive measure have never been effective (because, by definition, the addiction will likely not be deterred by punishment). However, what's quite refreshing about this book is that by framing the compulsion to engage in addiction as a learned behavior (that may seem fixed because of our brain's tendency to take the path of least resistance), it also presents a road to recovery that involves learning (or unlearning, as the case may be). This hinges on the concept of neuroplasticity, or understanding that we can change our brain. Unlearning behaviors is difficult, but not impossible. This deviates from the disease model of addiction which proposes that people are powerless in the face of their disease. However, it also doesn't tip toward the moralistic "choice" model, that blames addicted people for being weak. Instead, it acknowledges the neurodiversity in all of us, and opens up an understanding of various types of "personalities" or inherited neurochemical traits, and how they may react to various environmental influences, that, when mixed with exposure to mind/brain-chemically-altering influences (such as drugs, gambling, etc), can lead to compulsive use of these drugs, despite the mounting negative consequences. And she's careful not to demonize those with these sorts of "predispositions." Like many character traits that can be seen as having positive and negative qualities (e.g. obstinance can make someone difficult to work with, but might also make them strong leaders), someone who persists in the face of negative consequences, could be a resilient survivor or activist. And while she didn't say this directly, in a way, they are the ultimate optimist. However, she paints a real picture of the destruction that addiction can bring to someone's life, and advocates for a holistic system that can provide choices to people in various phases of their readiness/ability to unlearn their addiction, including harm reduction, medical intervention, and peer support. She also reminds us that whatever set of circumstances that existed before or may have contributed to learning addiction must also be adequately identified and addressed, whether it's anxiety, ADD, spectrum-related challenges, etc.

The only reason I didn't give it 5 stars is that the writing was a little hard to follow at times. Some points were repetitive, while others I think could have been fleshed out or explained a little more thoroughly, and the overall flow was a little confusing at times. There were also a few jumps in logic that I couldn't quite make with her.

However, I noticed that some knocked this book for not having research to back up the assertions, but this is not true. Please remember to check the back of the book. She cites references for every chapter. However, I admittedly didn't follow up on the referenced works to see if I agreed with her conclusions.

[Ron Johnson · Rating 5 out of 5]

Wow! This is one heck of a study on addiction. Most of it I got, but there were times when the author had me in the weeds. Looking at addiction using different models was not new to me, but the author develops the learning model more than I had seen before.

I learned a lot from this book, but I don't recommend it to people just starting to deal with addiction. Some base level knowledge of the 12 Step Model and the Disease Model is important to understanding the book. I have dealt with my son's addiction for ten years, been through 4 residual treatment centers (3 of which were $40,000 or more a pop). I now know in my core that one size does not fit all and that a full and complete understanding of treatment center's offerings in essential to matching the client to the provider.

Also, I listened to this book on Amazon Audible. If I had read this traditionally, I don't think I would have gotten through it.

[Wendy · Rating 5 out of 5]

I think this is a brilliant book, highly intelligent and well presented, too. I think everyone should really pick it up and give it a read because we all know someone who struggles with addiction. It gave me an entirely new perspective on the issue!

Disclaimer: I was provided with a complimentary copy of this title to facilitate review. No other compensation was received. All opinions are 100% my own.

[Eira Grey · Rating 4 out of 5]

Fascinating take on viewing addiction as a learning disorder, rather than a "disease". Szalavitz writes in a concise, easy-to-read manner (which was a relief, because, neuroscience) and makes a strong case. This book has helped me change my views on addiction and provides a lot of really useful, practical information for clinicians and human services workers.

[Susan Jane · Rating 2 out of 5]

I just didn’t love this book. It wasn’t what I expected when I picked it up. I’d hoped to learn more about addiction in general, her personal experience as an addict, and more of the facts. I definitely felt like in the end it became very political and opinionated, and I didn’t agree necessarily with a good portion of what she was arguing. Yes, she wrote the book well in regards to the format and writing style. However, it really just wasn’t what I had wanted it to be.

[Marsinay · Rating 4 out of 5]

An extremely well-done meta-analysis of the research to date on addiction and drug use. Szalavitz argues that addiction is better understood as a learning disorder than "either a disease model of complete slavery to drugs or a moral model of completely free choice."

She discusses the history, nature and biology of addiction and delves into which types of treatment tend to be successful versus those that are ineffective. She also offers an overview of different drug policies throughout the world, comparing the data collected from each.

Overall, Szalavitz emphasizes the importance of science and research in guiding our understanding and in implementing policy. So much wisdom and clarity can be gained from that simple (but profound) idea alone.

I desperately hope that this book helps to change the way our society understands and deals with addiction.

[Shannon Minninger · Rating 5 out of 5]

How many more books like this will it take before we, as a society, begin to change our beliefs and practices about addiction? Clearly, and unfortunately for us all, if you read through the many reviews already posted about this book, it will require many more books and a lot more than books, though it is clear beyond a shadow of a doubt that it is our current systems that are broken, not the brains of the addicted. The “more we understand that addiction is a learning disorder and that drug use is often a rational response to an unfair and painful world, the closer we’ll get to good policy.” It is ridiculous that we use antiquated policy and treatment regimens, that have absolutely no clinical or medical basis, as our primary treatment for addiction when we have empirical data to support alternative treatments. If we know better, there is no excuse for not doing better. “One of the sad ironies of our current drug policy is that the same treatment providers who have been cheerleaders for the war on drugs and who advocate the ongoing criminalization of drug use also claim to want to destigmatize ‘the disease of addiction.’ As they call for spirituality, prayer, confession, and restitution as treatment for a ‘brain disease,’ they fail to recognize that this moralistic language, the use of coercive and humiliating treatments, and the idea that the criminal justice system can address addiction are by their very nature antithetical to the goal of reducing stigma.” We cannot have our cake and eat if too. If we know, and we do, that addiction is a disease we have to treat it with scientifically proven methods. That is not to say that prayer and faith can’t have a part in the recovery, but just like we wouldn’t shame a cancer patient for losing their hair or deny them every scientific discovery to treat their disease, we shouldn’t treat our addicts that way either. We should support them in every way we know to help them overcome their disease but if they choose to not accept treatment, and there are plenty of cancer patients who certainly opt out of treatment, we have to allow them that freedom.

[Sara · Rating 3 out of 5]

The accomplishment of this book is in presenting addiction not as an on/ off switch in which one is either an addict and thus an addict forever or not an addict, with no in-between. Instead Szalavitz emphasizes over and over again that addiction is in many cases learned -- what you use the drug for, what your peer group expects from your drug usage, the setting in which you consume drugs -- all contribute to an experience of substance usage that either gradually becomes more and more compulsive, or simply fails to take complete hold. Probably her most striking observation is that almost all US anti-drug crusades entirely ignore the fact that drug users do get something positive from their drug use -- at least at first. Instead, in public service rhetoric, drugs are always a stupid choice made by losers who just haven't thought things through. Svalavitz again and again points out that for people dealing with the profound pain of traumatic memories, for people with the darting brains of ADHD, for folks with profound depression or social anxiety, drugs can offer very concrete relief from brains that make basic living very difficult. And in the US, where getting affordable access to mental health care is challenging even for the middle class, drugs might be the only relief from a brain that is torturing you. However, once you've sought relief in drugs, the unrelenting shame heaped on drug users is not much of an incentive to stop. Shame is almost never a motivator, even for the most clear-headed among us. For those whose brains make living hard, its just one more reason to tune out with more drugs.

She advocates for more room in the US mental health industry for addiction care based on harm reduction. This approach, in contrast to AA's very black and white once-an-addict-always-an-addict, encourages drug users to reflect on what motivates them to regulate and control their drug use even if they cannot stop it. Are they motivated to use clean needles to protect them from HIV, even if they are not motivated to stop using? Are they motivated to limit the hours in which they take drugs in order to hold down a job? Harm reduction starts with the motivations the user is experiencing right now, with the hope (but not the condition) that it might open up a space for them to reflect further on what they are using the drug for. Once a user sees that they can apply their motivation (rather than a rehab facility's dictates) to controlling their usage, they have a much stronger sense of their autonomy over their drug usage. She cites specific studies which document the effectiveness of this approach for some users. Perhaps her most frequent refrain is that not all addicts are alike, and that what works for one addict does not necessarily work for all addicts. And yet in the US, the main assistance offered to addicts is in the form of a 12-step program which can be very very very rigid in its rhetoric and execution.

This is a message that most Americans -- both drug users and non-drug users -- need to be exposed to. In laying out the information, Svalavitz is on the side of the angels. The message simply needs to be heard more. All the same, the book wasn't quite what I expected based on its advanced publicity, which made it seem more geared specifically toward drug users and those who care about them, offering them new approaches to dealing with addiction. This is mostly the function of the last two chapters. The bulk of the book offers a more broad policy survey of addiction treatment in America, noting its roots in racism, and the war on drugs' general lack of results. My guess is that individual buyers motivated to pick up Svalavitz's book already know a lot of this. The ideal reader of this book struck me as a student taking an addiction psychology or criminal justice course. I hope it gets picked up in the college classroom by folks who haven't thought much about addiction one way or another.

I have two gripes with the book: 1) Before she ever addresses her own largely positive experience in 12-step programs, she repeats over and over again, in almost every chapter, how horrible 12-step programs are, for the way they shame their participants. But in the end, Svalavitz's real gripe is with a particular application of the 12-step model in a particular group that owns a lot of rehab centers. She confesses that the 12-step model provided her with community and a sense of purpose when she was in recovery. The practice in AA of listing your faults and making amends can be quite shaming. Or it can be quite conciliatory -- at its best, I think it was conceived of as a way for those who had terrible shame or anxiety to speak out loud their worst fears about themselves to a group of people who experience some of the same darkness -- and to know that the whole group, instead of recoiling in horror, will simply nod and say yes, we identify and you are one of us. I don't doubt that 12-step programs are applied in all kinds of abusive ways in some rehab centers. I also think that the 12 steps provide a lot of people with a sense of autonomy and community they need to change their lives. I found the anti-12 step rhetoric to be overblown for the actual amount of concrete problems she reported in her chapter focusing on it. The refrain she repeats over and over about 12-step programs is that there's no good empirical evidence that shows that it works. That's worth discussing. It's worthwhile to organize for more funding, more research, more responsible addiction treatment. But still, IT'S ALL WE'VE GOT RIGHT NOW. Her anti-12-step rhetoric often felt like someone coming along and tearing down the tent because it was a tent, and saying "Well, we should have a sky-scraper instead." Yes, we should. But until that day, we need some kind of shelter.

2) I also think her own experience -- as a teen who abused drugs while living away from her home and before anyone was relying on her in an adult capacity -- leads her to underestimate the severe harm drug abuse does to the families of drug users. She criticizes psychological discourse that urges family members to separate themselves from drug users, and she also criticizes the way the concept of "rock bottom" (which is just a metaphor -- I've never understood it as anything but a metaphor) is used in addiction speak to discourage those closest to the addict from trying to interfere. What is missing in her book is the limitless anguish, the limitless expense, the genuine danger to children and the elderly that drug users bring to their family and loved ones. The concept of harm reduction itself emphasizes that the motivation of the drug user, not the support of the family members is the crucial factor in allowing the drug user to gain control over their situation. While I take Svalavitz's point very seriously that not all addictions are the same, for very many drug users there is almost nothing that family can do, and it does become their responsibility to try not to join the drug user on the downward spiral. This is a dynamic that the book does not have on its horizons at all.

[Sabin · Rating 4 out of 5]

I absolutely devoured this book. I read it or listened to it as the situation allowed, and could not put it down. The subject matter and its degree of novelty to me made it irresistible.

The structure of the book centres around the author's own story of recovery from intravenous drug abuse and advocates a huge overhaul of drug policies by beginning with the understanding that addiction is primarily a learning disorder. In order to build her case, the author sums up research in the nature of addiction and its similarities to experimental results obtained by B. F. Skinner in his behaviourist experiments. She also makes a summary of existing drug policies worldwide, their racial origins, discussing also New Zealand's experiment in legalising recreational drugs. Subsequently, she makes suggestions on how to approach the issue from an angle which yields more positive results.

The only books on addiction which I previously read are Gabor Mate's In the Realm of Hungry Ghosts: Close Encounters with Addiction and William S. Burrough's Junky. While Gabor Mate's book has a similar approach to this subject, Junky and this book feel a lot more authentic. I mean heroin addiction and recovery has to count for something when put side by side with binge buying classical music CDs. The author here brings an American perspective and also cites the newer research into addiction, which overwhelmingly points to the need for big changes in policy in order to reduce the harm done by drug abuse.

I enjoyed this book tremendously and I was left hungry for more information about how different classes of drugs modify brain processes and about the way that translates to conscious experience. Thankfully the book gave me some tips for further study.

[Go MIche · Rating 2 out of 5]

Not sure there was anything revolutionary about her discoveries or introducing the concept that addiction is a learning disorder I think the idea that the causes and treatment for addiction are complicated and there is no single cause or cure for addiction has been covered and is widely not something that most experts can agree on today.Brain disorder/moral failing/disease/choice/ spiritual disease/lack of discipline, it all plays in and everyone responds to different treatment and some not at all-this we know. Former High times writer explores addiction and slams AA, the courts, the idea of a brain disease, and supports decriminalization of drugs. Did not find the research objective but subjective to her own experiences and prejudices. Not sure if the idea of her own recovery story and a research book were good together, may have been one or the other with a clear goal for better recovery rather than criticizing current efforts or a personal recovery story which is fascinating considering she wrote for High Times and Spin magazines. Having said that, still worth the time to read if you enjoy exploring different views on addiction and recovery.

[Kat O · Rating 3 out of 5]

Not sure I learned anything new or revolutionary from this. Some interesting facts, but I don't see what the connection is still to learning. I already get that addiction is a learned behavior, but I don't feel like she makes a clear enough case about why in the book.

Certain chapters confused me too (love & addiction) and I'm not sure the case for neurodiversity is clear either, although I am advocate for such beliefs and the language.

I would love to know more about correlation between mental health diagnoses as underlying, untreated, primary deficit that drug users might be trying to cope with by using drugs or self treat for. I personally wonder if that is key to use in first place.

Last two chapters are most interesting- New Zealand and Portugal's decriminalization and chapter on harm reduction.

With all the interviews and press about this book I expected to be wowed.

[Miranda · Rating 5 out of 5]

I've been reading a ton of addiction-related literature within the past four years...this book is possibly the best I've encountered thus far. From the author's fresh perspective on the nature of addiction, to what can possibly be done to change our relationship, as a nation and globally, to drugs and those who choose to use them, to her own experiences as a user-dealer-perpetrator...this tome was chock full of useful, hopeful, timely and necessary information. Highly recommended, along with "The Big Fix: Hope After Heroin" by Tracey Helton Mitchell, "Chasing the Scream" by Johann Hari, "In The Realm of Hungry Ghosts" by Gabor Mate, "Dreamland" by Sam Quinones and "Inside Rehab" by Anne Fletcher.

[Amy · Rating 3 out of 5]

Heard about this book while driving and listening to NPR and from Huffington Post. I've always been interested in learning differences and autism, so wanted to read this book suggesting that "addiction is a developmental disorder--a problem involving timing and learning, more similar to autism, ADHD, and dyslexia than it is to cancer...the addicted brain has simply undergone a different course of development....addiction is a wiring difference, not necessarily a destruction of tissue." It is an interesting read, even if you skim some of the chapters (I did). I would love to hear what psychologists think.

[Pam · Rating 4 out of 5]

I have mixed feelings on this book. As a personal memoir and a history of our country's dealings with addiction, I'd give it 5 stars. As a research on addiction being classed as a behavioral disability similar to Aspberger and Autism, I'd give it 3 stars. That premise, while fascinating and plausible was not sufficiently supported with scientific research results to convince me. It definitely made me think, made me revisit some of my own assumptions, and kept my interest from the first to the last sentence. I'd recommend this book to anyone dealing with any type of addiction and/or those who have loved ones or students dealing with addiction.

[Renae · Rating 5 out of 5]

Absolutely brilliant! Validating, compassionate and truly "a revolutionary new way of understanding addiction." I will be applying Maia's clearly articulated findings and insight to my work. Treat everyone with respect and compassion, build on their strengths and encourage them, celebrating each and every victory!!! Unconditional support! Meet people where they are at! Yes! There are too many beautiful concepts to mention here, but I will be using this book as the foundation for my practice and I encourage everyone to read this book. Let's eliminate stigma and open up discussion on addiction and how we can compassionately help others!

[RITA BUTTERFIELD · Rating 3 out of 5]

Interesting ideas, but I wish it hadn't been couched so much in the author's own story.

[Ryan · Rating 4 out of 5]

Another great book about addiction in 2016 (the other one I read was Chasing the Scream).

I marked lots of pages in this one. Here are some of my favorite excerpts:

Addiction is not created simply by exposure to drugs, nor is it the inevitable outcome of having a certain personality type or genetic background, though these factors pay a role. Instead, addiction is a learned relationship between the timing and pattern of the exposure to substances or other potentially addictive experiences and a person's predispositions, cultural and physical environment, and social and emotional needs. Brain maturation stage is also important: Addiction is far less common in people who use drugs for the first time after age 25, and it often remits with or without treatment among people in their mid-20s, just as the brain becomes fully adult. In fact, 90% of all substance addictions start in adolescence, and most illegal drug addictions end by age 30.

If addiction is a learning disorder, fighting a "war on drugs" is useless. Surprisingly, only 10-20% of those who try even the most stigmatized drugs like heroin, crack, and methamphetamine become addicted. And that group, which tends to have a significant history of childhood trauma and/preexisting mental illness, will usually find some way of compulsively self-medicating, no matter how much we crack down on one substance or another. In this context, trying to end addiction by attempting to eliminate particular drugs is like trying to cure compulsive hand washing by banning one soap after another. Although you might get people to use more or less harmful substances while in the grips of their compulsions, you aren't addressing the real problem.

The addicted brain isn't broken- it's simply undergone a different course of development. Like ADHD or autism, addiction is what you might call a wiring difference, not necessarily a destruction if tissue, although some doses of some drugs can indeed injure brain cells.

It's almost impossible to force or coerce learning - especially to alter behavior that has already become habitual. As BF Skinner himself observed, "A person who has been punished is not less inclined to behave in a given way; at best, he learns how to avoid punishment."

When brain pathways intended to promote eating, social connection, reproduction, and parenting are diverted into addiction, their blessings can become curses. Love and addiction are alterations of the same brain circuits, which is why caring and connection are essential to recovery, too.

Research suggests that having an intention to do something only predicts engaging in the desired behavior about 33% of the time, even for people without drug problems. Learning a new behavior typically takes time.

Whatever the evolutionary precursors of drug use are, a permanently "drug free" human culture has yet to be discovered. Like music, language, art, and tool use, the pursuit of altered states of consciousness is a human universal.

If you've viewed media coverage of crack or heroin addiction "spreading to the middle class": or read stories written by a white person who claims to be "not your typical addict," you are essentially hearing the echoes of the racist origins of contemporary ideas about addictions.

Some insurers estimated that alcoholism rates rose by 300% as Prohibition continued. Meanwhile, the murder rate went from 6.5 per 100,000 in 1918 before Prohibition to 9.7 per 100,00 in 1933, the year of repeal, nearly a 50% rise.

What matters in addiction is what you want or, yes, believe you need, not whether you feel sick or even how sick you feel.

In addiction, adolescence is the high-risk period because this is when the brain changes to prepare for adult sexuality and responsibilities and when people begin to develop ways of coping that will serve them for the rest of their lives. For example, the odds of alcoholism for those who start drinking at age 14 or younger are nearly 50% - but they drop to 9% for those who start at age 21 or later.

For many, if not most, people with addiction, trauma is perhaps the critical factor that causes the problem.

If the brain is overwhelmed by stress in adolescence when key circuitry is developing, it can affect the way it reacts throughout later life.

The problem isn't the existence of activities and substances that offer escape; it's the need for relief and the learned pattern of seeking it that matters.

Changes in dopamine signaling during adolescence attract teens toward new, dangerous, exciting challenges to replace the lost thrills of childhood - and to slay boredom.

Dopamine is a much misunderstood neurotransmitter. Found in less than 1 million neurons - a tiny proportion of the 86 billion such cells in the brain - it has an outsized impact.

Simply by creating an unpredictable pattern of highs and lows, gambling and other behaviors can become addictive- and the fact that this occurs without a drug offers insight into what happens with psychoactive substances and why addiction risk exists at all. A pattern seeking brain is prone to getting fooled by random rewards that only appear linked with behavior; attempting to find structure in intermittent reinforcement can get us stuck looking for an order that doesn't exist.

Maintenance treatments are the only therapies that can lower mortality by 75% - something that would be considered a miraculous success in any other type of treatment but addiction care.

For street users, the irregularity of supply and timing means that drug wanting is sensitized: taking large, irregular doses is the best way to increase "wanting" via sensitization.

People with decent jobs, strong relationships, and good mental health rarely give that all up for intoxicating drugs; instead, drugs are powerful primarily when the rest of your life is broken.

We get addicted only in certain contexts, which makes all the difference in terms of whether any given human will eat normal amounts of sugar, binge on it, take cocaine occasionally, or become a full-on crack addict. By itself, nothing is addictive; drugs can only be addictive in the context of set, setting, dose, dosing pattern, and numerous other personal, biological, and cultural variables. Addiction isn't just taking drugs, It is a pattern of learned behavior. It only develops when vulnerable people interact with potentially addictive experiences at the wrong time, in the wrong places, and in the wrong pattern for them. It is a learning disorder because this combination of factors intersects to produce harmful and destructive behavior that is difficult to stop.

Research finds that loneliness can be as dangerous to health as smoking and more harmful than obesity. The more and higher-quality relationships a person has, the more mentally and physically healthy they tend to be.

Consider a prisoner who is locked in a cell that contains a completely hidden trapdoor to an escape route. On the surface, there is no way out: the bars are strong and placed tightly together, the walls are stone, and the door is securely locked. The window is out of reach, and too small and barred. If the prisoner does not know that the possibility of escape exists via the trapdoor, she is not "free" to choose it- even though another prisoner who does have that information can easily liberate himself. By analogy, while addicted there are alternative behaviors available to you- and you sometimes even recognize that they do exist - but you simply can't enact them or believe with enough conviction that they will genuinely help to power yourself through the necessary changes.

While there are certainly legitimate policy arguments about the best way to deal with crimes like drug dealing, there's no doubt that the criminal Justice system is ineffective and often actively counterproductive in dealing with addiction.

Think about it for a minute: addicted people continue taking drugs despite losing jobs, loved ones, their homes, families, children, dreams, even sometimes body parts. I continued after contracting a disease that made me feel as though I had been poisoned. I continued after being suspended from the school I'd spent most of my life dreaming of and working toward attending. I continued while facing the daily risk of overdose and AIDS - after I'd already nearly died from an overdose and contracted hepatitis. And I continued even when the cocaine made me feel paranoid, terrified, and as though I was about to die, even though the thing that most frightened me of all was death. In this light, the idea that other sorts of threats or painful experiences will stop addiction makes no sense. Addiction is an attempt to manage distress that becomes a learned and nearly automatic program. Adding increased distress doesn't override this programming; in fact, it tends to engage it even further.

From all types of studies, there's no doubt that incarceration itself doesn't stop addiction.

The evidence on what makes for successful recovery actually contradicts the "bottom" story: people are actually more likely to recover when they still have jobs, family, and greater ties to mainstream society, not less.

The "designated driver" is a harm reduction approach: it accepts that people will drink to excess and works to cut drunk driving, not drinking.

From the harm reduction perspective, drug use and even addiction isn't necessarily irrational; it's a response to the environment and people can learn to make better choices about it.

When people start to be valued by others, they start to value themselves.

How do you define a low-risk recreational dug? The question is more mind-bending that it might first appear. Accepting the level of risk associated with, say, cigarettes would legalize virtually anything short of absolute poison; after all, half of heavy smokers die from their habit. If you set the level of risk associated with alcohol as your standard, numerous deaths and injuries would still be acceptable: booze causes six percent of deaths worldwide.

Because there is always a demand for mood altering substances and the most vulnerable people are the most likely to get addicted, absolute prohibition tends to deter those who aren't at risk and harm those who are, by criminalizing them.

Cigarettes themselves haven't changed much - and if they have, it's in the direction of becoming more addictive. Nor is it likely that the number of people with predispositions to become addicted dropped. And tobacco has not been prohibited. What has changed is the cultural and physical environment where cigarette addiction is learned. By reducing the number of times cigarettes can easily be smoked and the number of situations where smoking is socially accepted, the opportunity too learn addiction has been reduced.

It is impossible to simultaneously criminalize and destigmatize a behavior: one of the key points of criminalization is, in fact, to deliberately create stigma in order to deter lawbreaking.

[J L McCoy · Rating 4 out of 5]

I do not think this is a theoretical work, nor is it explaining a new method of treating addiction - which is what I was expecting when I read the description. What it is, is an in-depth explanation of the various factors that set the stage for addiction, as well as a critical commentary of how substance use treatment and related public policies fail to effectively treat and address substance use disorders. It identifies policy areas that the author believes should be focused on, as well as highlighting interventions that have been shown to be more effective.

I think the central premise - of identifying addictions as a learning disorder - is distracting in some ways from the goals of the book. The author is trying to change how the general public conceptualizes addiction, and in this context, urging people to think about it as a learning disorder makes some sense. But for people who work in this field, it doesn't seem to work well. For anyone working in behavioral health where your focus is on evidence-based, dual diagnosis treatment, nothing in this book will be news - except what I can only hope is outdated information, that most treatment is 12-step based. If you are not in the aforementioned group, this is a great summary of how social workers and treatment providers view substance use disorders, and try to support recovery. It is also great for anyone wanting to understand why people advocate for decriminalizing substance use.

I think it's a great read, and I would recommend the book to everyone. It will help anyone either develop an informed perspective on substance use and addiction treatment, or aid in articulating it.