The Likely Cause of Addiction Has Been Discovered and It Is Not What You Think
It is now 100 years since drugs were first banned, and all through this long century of waging war on drugs, we have been told a story about addiction, by our teachers and by our governments. This story is so deeply ingrained in our minds that we take it for granted. It seems obvious. It seems manifestly true. Until I set off three and a half years ago on a 30,000-mile journey for my book Chasing The Scream: The First And Last Days of the War on Drugs to figure out what is really driving the drug war, I believed it too. But what I learned on the road is that almost everything we have been told about addiction is wrong. There is a very different story waiting for us, if only we are ready to hear it.
If we truly absorb this new story, we will have to change a lot more than the drug war. We will have to change ourselves.
I learned it from an extraordinary mixture of people I met on my travels: From the surviving friends of Billie Holiday, who helped me to learn how the founder of the war on drugs stalked and helped to kill her; from a Jewish doctor who was smuggled out of the Budapest ghetto as a baby, only to unlock the secrets of addiction as a grown man; from a transsexual crack dealer in Brooklyn who was conceived when his mother, a crack-addict, was raped by his father, an NYPD officer; from a man who was kept at the bottom of a well for two years by a torturing dictatorship, only to emerge to be elected president of Uruguay and begin the last days of the war on drugs.
I had a personal reason to search for these answers. One of my earliest memories as a kid is trying to wake up one of my relatives, and not being able to. Ever since then, I have been turning over the essential mystery of addiction in my mind. What causes some people to become fixated on a drug or a behavior until they can't stop? How do we help those people to come back to us? As I got older, another of my close relatives developed a cocaine addiction, and I fell into a relationship with a heroin addict. I guess addiction felt like home to me.
If you had asked me what causes drug addiction at the start, I would have said, "Drugs. Duh." It's not difficult to grasp. I thought I had seen it in my own life. We can all explain it. Imagine if you and I and the next 20 people to pass us on the street take a really potent drug for 20 days. There are strong chemical hooks in these drugs, so if we stopped on day 21, our bodies would need the chemical. We would have a ferocious craving. We would be addicted. That's what addiction means.
One of the ways this theory was first established is through rat experiments which were injected into the American psyche in the 1980s, in a famous advert by the Partnership for a Drug-Free America. You may remember it. The experiment is simple. Put a rat in a cage, alone, with two water bottles. One is water. The other is water laced with heroin or cocaine. Almost every time you run this experiment, the rat will become obsessed with the drugged water, and keep coming back for more, until it kills itself.
The advert explains: "Only one drug is so addictive, nine out of 10 laboratory rats will use it. And use it. And use it. Until dead. It's called cocaine. And it can do the same thing to you."
But in the 1970s, Vancouver psychology professor Bruce Alexander noticed something odd about this experiment. The rat is put in the cage all alone. It has nothing to do but take the drugs. What would happen, he wondered, if we tried this differently? So Alexander built Rat Park, a lush cage where the rats had colored balls and the best rat food and tunnels to scamper down and plenty of friends: everything a rat could want. What, Alexander wanted to know, would happen then?
In Rat Park, all the rats obviously tried both water bottles, because they didn't know what was in them. But what happened next was startling.
The rats with good lives didn't like the drugged water. They mostly shunned it, consuming less than a quarter of the drugs the isolated rats had used. None of them died. While all the rats who were alone and unhappy became heavy users, none of the rats who had a happy environment did.
At first, I thought this was merely a quirk of rats, until I discovered that at the same time as the Rat Park experiment there was a helpful human equivalent taking place. It was called the Vietnam War. Time magazine reported heroin was "as common as chewing gum" among U.S. soldiers, and there is solid evidence to back this up: some 20 percent of U.S. soldiers became addicted to heroin there, according to a study published in the Archives of General Psychiatry. Many people were understandably terrified: they believed a huge number of addicts were about to head home when the war ended.
But in fact, some 95 percent of the addicted soldiers, according to the same study, simply stopped using. Very few had rehab. They shifted from a terrifying cage back to a pleasant one, so they didn't want the drug anymore.
Bruce Alexander argues this discovery is a profound challenge both to the right-wing view that addiction is a moral failing caused by too much hedonistic partying, and the liberal view that addiction is a disease taking place in a chemically hijacked brain. In fact, he argues, addiction is an adaptation. It's not you: It's your cage.
After the first phase of Rat Park, Alexander took the test further. He repeated the early experiments, where the rats were left alone and became compulsive users of the drug. He let them use for 57 days; if anything can hook you, it's that. Then he took them out of isolation, and placed them in Rat Park. He wanted to know, if you fall into that state of addiction, is your brain hijacked so you can't recover? Do the drugs take over? What happened is striking. The rats seemed to have a few twitches of withdrawal, but they soon stopped their heavy use, and went back to having a normal life. The good cage saved them. (The full references to all the studies I am discussing are in the book.)
This new theory is such a radical assault on what we have been told it felt like it could not be true. But the more scientists I interviewed, and the more I looked at their studies, the more I discovered things that don't seem to make sense—unless you take into account this new approach.
Here's one example of an experiment that is happening all around you, and may well happen to you one day. If you get run over today and you break your hip, you will probably be given diamorphine, the medical name for heroin. In the hospital around you, there will be plenty of people also given heroin for long periods, for pain relief. The heroin you get from your doctor will have a much higher purity and potency than the heroin being used by street addicts, who have to buy from criminals who adulterate it. So if the old theory of addiction is right—it's the drugs that cause it; they make your body need them—it's obvious what should happen. Loads of people should leave the hospital and try to score smack on the streets, to meet their habits.
But here's the strange thing. It virtually never happens. As the Canadian doctor Gabor Mate was the first to explain to me, medical users just stop, despite months of use. The same drug, used for the same length of time, turns street users into desperate addicts—and leaves medical patients unaffected.
If you still believe, as I used to, that addiction is caused by chemical hooks, this makes no sense. But if you believe Bruce Alexander's theory, the picture falls into place. The street addict is like a rat in the first cage: isolated and alone, with only one source of solace to turn to. The medical patient is like a rat in the second cage: going home to a life where she is surrounded by the people she loves. The drug is the same, but the environment is different.
This gives us an insight that goes much deeper than the need to understand addicts. Professor Peter Cohen argues that human beings have a deep need to bond and form connections. If we can't connect with each other, we will connect with anything we can find—the whirr of a roulette wheel or the prick of a syringe. He says we should stop talking about "addiction" altogether and instead call it "bonding." A heroin addict has bonded with heroin because she couldn't bond as fully with anything else.
So the opposite of addiction is not sobriety. It is human connection.
I still couldn't shake off a nagging doubt. Are these scientists saying chemical hooks make no difference? It was explained to me: you can become addicted to gambling, and nobody thinks you inject a pack of cards into your veins. You can have all the addiction and none of the chemical hooks. I went to a Gamblers Anonymous meeting in Las Vegas and they were as plainly addicted as the cocaine and heroin addicts I have known. Yet there are no chemical hooks on a craps table.
But surely, I asked, there is some role for the chemicals? It turns out there is an experiment which gives us the answer to this in precise terms, which I learned about in Richard DeGrandpre's book The Cult of Pharmacology.
Everyone agrees cigarette smoking is one of the most addictive processes around. The chemical hooks in tobacco come from a drug called nicotine. So when nicotine patches were developed in the early 1990s, there was a huge surge of optimism—cigarette smokers could get all of their chemical hooks, without the other filthy, and deadly, effects of cigarette smoking. They would be freed.
But the Office of the Surgeon General has found that just 17.7 percent of cigarette smokers are able to stop using nicotine patches. That's not nothing. If the chemicals drive 17.7 percent of addiction, as this shows, that's still millions of lives ruined globally. But what it reveals again is that the story we have been taught about the cause of addiction being chemical hooks is real, but it's only a minor part of a much bigger picture.
This has huge implications for the 100-year-old war on drugs. This massive war, which kills people from the plazas of Mexico to the streets of Liverpool, is based on the claim that we need to physically eradicate a whole array of chemicals because they hijack people's brains and cause addiction. But if drugs aren't the driver of addiction— if, in fact, it is disconnection that drives addiction—then this makes no sense.
Ironically, the war on drugs actually increases all those larger drivers of addiction. I visited a prison in Arizona, Tent City, where inmates are detained in tiny stone isolation cages (the Hole) for weeks on end, to punish them for drug use. It is as close to a human re-creation of the cages that guaranteed deadly addiction in rats as I can imagine. When those prisoners get out of prison, they will be unemployable because of their criminal record, guaranteeing they will be cut off even more.
There is an alternative. We can build a system that is designed to help drug addicts reconnect with the world and leave behind their addictions.
This isn't theoretical. It is happening. Nearly 15 years ago, Portugal had one of the worst drug problems in Europe. They had tried a drug war, and the problem just kept getting worse. So they decided to do something radically different. They resolved to decriminalize all drugs, and take all the money they once spent on arresting and jailing drug addicts, and spend it instead on reconnecting them—to their own feelings, and to the wider society. The most crucial step was to get them secure housing and subsidized jobs, so they had a purpose in life, and something to get out of bed for. In warm and welcoming clinics, addicts are taught how to reconnect with their feelings, after years of trauma. One group of addicts was given a loan to set up a removals firm. Suddenly, they were a group, all bonded to each other and to society, and responsible for each other's care.
An independent study by the British Journal of Criminology found that since total decriminalization, addiction has fallen, and intraveneous drug use is down by 50 percent. Decriminalization has been such a success that very few people in Portugal want to go back to the old system. The main campaigner against the decriminalization back in 2000 was Joao Figueira, the country's top drug cop. He offered all the dire warnings we would expect from the Daily Mail or Fox News. But when we sat together in Lisbon, he told me that everything he predicted had not come to pass—and he now hopes the whole world will follow Portugal's example.
This isn't only relevant to the addicts I love. It is relevant to all of us, because it forces us to think differently about ourselves. Human beings are bonding animals. We need to connect and love. The wisest sentence of the 20th century was E.M. Forster's, "Only connect." But we have created an environment and a culture that cut us off from connection. The rise of addiction is a symptom of a deeper sickness in the way we live, constantly directing our gaze toward the next shiny object we should buy, rather than the human beings all around us.
The writer George Monbiot has called this the "age of loneliness." We have created human societies where it is easier for people to become cut off from all human connection. The Internet offers only a parody of connection. Bruce Alexander, the creator of Rat Park, told me that for too long, we have talked exclusively about individual recovery from addiction. We need now to talk about social recovery; how we all recover, together, from the sickness of isolation.
But this new evidence isn't just a challenge to us politically. It doesn't just force us to change our minds; it forces us to change our hearts.
Loving an addict is really hard. When I looked at the addicts I love, it was always tempting to follow the tough love advice doled out by reality shows like "Intervention": Tell the addict to shape up, or cut them off. Their message is that an addict who won't stop should be shunned. It's the logic of the drug war, imported into our private lives. But that will only deepen their addiction, and you may lose them all together. I came home determined to bind the addicts in my life closer to me than ever, to let them know I love them unconditionally, whether they stop, or whether they can't.
When I returned from my long journey, I looked at my ex-boyfriend, in withdrawal, trembling on my spare bed, and I thought about him differently. For a century now, we have been singing war songs about addicts. It occurred to me that we should have been singing love songs to them all along.
Johann Hari will be discussing his book at Politics and Prose in Washington DC, 7pm, January 29; at 92nd Street Y in New York City, noon, January 30; and at Red Emma's in Baltimore, on February 4.