If Addiction Is a Disease, Why Is It Criminalized?
President Obama has unveiled a series of steps aimed at addressing the epidemic of opioid addiction in the United States. We speak with journalist Maia Szalavitz about her new book, "Unbroken Brain: A Revolutionary New Way of Understanding Addiction," and about her own experience of overcoming addiction. "We need to create a more compassionate and loving drug policy," Szalavitz says. "Nobody is going to believe that addiction is a disease as long as the behavior is criminal." Szalavitz is one of the leading journalists covering addiction in the United States. Watch Part 1 of our interview here.
AMY GOODMAN: This is Democracy Now!, democracynow.org, The War and Peace Report. I’m Amy Goodman, with Juan GonzÃ¡lez.
JUAN GONZÃLEZ: Well, on Tuesday, President Obama vowed to step up the fight against heroin and opioid addiction by treating addiction as a health issue, not a criminal problem. Obama made the comment while speaking at the National [Rx] Drug Abuse & Heroin Summit in Atlanta.
PRESIDENT BARACK OBAMA: I think we have to be honest about this. Part of what has made it previously difficult to emphasize treatment over the criminal justice system has to do with the fact that the populations affected in the past were viewed as or stereotypically identified as poor, minority, and, as a consequence, the thinking was it is often a character flaw in those individuals who live in those communities, and it’s not our problem that they’re just being locked up. And I think that, you know, one of the things that’s changed in this opioid debate is a recognition that this reaches everybody.
AMY GOODMAN: We turn now to Part 2 of our conversation with Maia Szalavitz, a journalist who’s covered addiction for almost 30 years. She has written a piece inThe Guardian headlined "Curbing Pain Prescriptions Won’t Reduce Overdoses. More Drug Treatment Will." Her brand new book is called Unbroken Brain: A Revolutionary New Way of Understanding Addiction.
Unbroken Brain, Maia, what do you mean?
MAIA SZALAVITZ: Well, I mean that the dialogue around addiction has always focused on it being a chronic progressive disease that gets worse and worse and that almost nobody overcomes. In fact, addiction is not progressive. If you look at the data, it shows that as you get older, you are more and more likely to recover, not less. So if it was progressive, the opposite would be the case. I say "unbroken brain" because what really happens in addiction is that your brain gets wired differently, just the way it gets wired differently when you fall in love or when you have a kid. It gets wired differently in a pathological way during addiction, but this is not a progressive disease. It does not break your brain. Love doesn’t break your brain. It may be very hard to get over a breakup, but most people do. And the kind of craving that you have for your ex, it’s the same exact stuff, because it’s mediated by the same brain pathways.
JUAN GONZÃLEZ: Well, you’ve made the point that about 75 percent of heroin addicts originally got hooked through—first through prescription pills, but that there—but solving the problem is not a matter of reducing drug prescriptions.
MAIA SZALAVITZ: Well, actually, the—what happens is the vast majority of people who become addicted to prescription pain medications are not pain patients. They are using somebody else’s prescription. Seventy-five to 80 percent are basically taking something out of your medicine cabinet, they’re buying it from dealers, they’re getting it from family and friends. These are teenagers and people in their twenties who are smoking pot, who may be doing a little coke. Seventy-five percent of them have taken coke. So, it’s hard to imagine a pain patient getting really into their opioids because they got addicted by a doctor and then going out and finding a coke dealer. That’s kind of an unbelievable thing to imagine.
What really is happening is that these people are heavily involved in drugs, and opioids are a drug that people who are heavily involved in drugs often eventually get to. I am not saying this to say that these people are bad people and pain patients are good people. It’s just that if we crack down on pain prescribing, we’re not going to target the people who are actually getting in trouble. And while some of those people may end up in chronic pain prescribing by doctor shopping and by pretending to have pain, just cutting people off from a prescription, whether it’s for pain or for addiction, does not solve the problem.
AMY GOODMAN: Although we discussed in Part 1 your own personal experience, I think it’s important to launch from there. So, for those who are just watching this, explain how you got addicted to heroin, how you got involved with coke, and then, this end, coming out of it and what has been most difficult for you.
MAIA SZALAVITZ: Sure. So, I was—I was a really, really geeky kid, and I was socially isolated. I was bullied. I just felt like I couldn’t connect with people. I was very good in school, and so I just sort of dove into academic interests. And I couldn’t understand why other people weren’t interested in the things I was obsessed with. I couldn’t really converse very well; I sort of lectured. And if anybody is familiar with the autistic condition called Asperger’s, I was basically a pretty classic case, but that diagnosis did not exist when I was a child, so I just thought I was bad. I thought like, "Well, everybody else likes people, and I like ideas, so I must be bad." And that sort of led to self-hatred. That led to depression. That led to cocaine. And ultimately that led to heroin.
When I was going to college, I was at Columbia. I was very intimidated by the preppies and all those kids who had, you know, so much money. And I felt like the only way to fit in was to bring something to the party, which was coke and which everybody wanted. And suddenly, you know, I was a person they wanted to have there. I didn’t have to worry that like, "Oh, god, they’re thinking, ’She’s coming.’" They’re like, "Yes, where is she already?" So, you know, it just worked that way. And then I got suspended from school as a result. And then I thought that—
AMY GOODMAN: For being a drug dealer?
MAIA SZALAVITZ: And then I thought that I had totally ruined my life, and I may as well use heroin. So, that’s the brief version.
JUAN GONZÃLEZ: And the road back? And most importantly, the decision then to make this a life’s work of trying to figure out what the root cause is and the solutions are?
MAIA SZALAVITZ: Sure. Well, I was facing legal consequences as a result of selling drugs. When I got arrested, the immediate result was to make the drug problem worse, because I just needed to escape. I managed to get bailed out, but I was like, you know, just shooting up even more after that.
AMY GOODMAN: How long were you addicted to heroin for?
MAIA SZALAVITZ: It was about three years. And what happened was, it was this experience of I kept doing it even though I knew it was hurting me and even though I knew that everything was going wrong. I felt like it was the only thing that made life livable. And, you know, I came to find out that addiction is basically defined as compulsive behavior despite negative consequences. And the irony here is that we use punishment, which is just another word for negative consequences, to try to stop addiction. And if that actually worked, addiction wouldn’t exist.
So, I went on this journey into recovery. I started in 1988. I went to your traditional 28-day rehab, because basically that was the only thing on offer. I thought at the time that, you know, that was the one true way and everybody should get that. And then I started to read the scientific literature, and I found that I had been sort of fed one set of myths on the street, one set in school, you know, another set kind of from the government and the media, and then another set even in rehab. And it wasn’t until I started reading the scientific literature that I began to understand what addiction really is. And that helped a lot during my recovery, as well.
The other thing I’d like to mention is that antidepressants were very important to my recovery. It took me five years to finally say, "OK, I’ll try this," because I was in a 12-step program, which at that time was very resistant to any kind of medication. And when I did, I found that it gave me that safety and comfort that I was looking for—not euphoria. I wasn’t going out and, you know, compulsively robbing drugstores to get Prozac. But it gave me that ability to be calm that I had just never had and that heroin had given me. And so, it allowed me to sort of be less sensory overload and less emotional overload. And that allowed me to connect with people, finally.
AMY GOODMAN: So, talk about—after being addicted and coming out of it, you said you realized everything wrong, you had been fed. This also goes to the issue of policy in the United States. What is wrong? What is right? And what do we completely misunderstand about addiction?
MAIA SZALAVITZ: Well, we have this dialogue over whether it’s a disease or a sin, and I think that it is sort of neither of those. If you want to call a learning disorder a disease, I’m not going to be upset about that. But I think that understanding what actually goes wrong, which involves learning, is critical to understanding addiction, because if we continue to use punishment to solve a problem that is defined by its resistance to punishment, we are not going to get very far. So I think understanding what it is is really important, because when people hear that addiction is a disease, they really don’t believe that, because the treatment for it tends to be either punishment or the 12-step programs, which involve prayer, confession and meeting. And if you went to a doctor for any other condition and you were told that you have to surrender to a higher power, you’d be like, "OK, I found a quack. I better go somewhere else." But in the addictions world, you’re told, "This is the only way, and you’re in denial. And the only alternative is jails, institutions and death." And so, while 12-step programs can be very, very helpful to lots of people, and they did help me, I think they are a self-help program. They are not medicine. And treatment should not be indoctrinating you into something that you can get for free and charging you $1,000 a day.
JUAN GONZÃLEZ: And from your investigations, the centers now of the new drug epidemic are places like Kentucky and West Virginia and New Hampshire—rural areas—as opposed to the urban areas that were the main centers decades ago. Why is that? What’s been happening in terms of rural America?
MAIA SZALAVITZ: Well, I think what we’re seeing, unfortunately, is the collapse of the white middle class. And if you look back at the crack epidemic, there were all these sort of scare headline stories about how crack is going to spread to the suburbs and crack is going to, you know, take over the middle class, etc., etc. That never happened. Why didn’t it happen? Because at the time, while black people were losing a lot of jobs to deinstitutionalization—to deindustrialization, and there was just high unemployment there in general, white people were still pretty protected at that point. Now that’s not the case.
And it’s kind of interesting that not only are we having an opioid epidemic, but we are having an epidemic of use of anti-anxiety pills. And, you know, the opioid epidemic has been blamed on drug companies’ like advertising and, you know, pain patients being told that pain is the fifth vital sign in all this. Well, anxiety is not the sixth vital sign. And that rose in conjunction with the opioids because people are looking for escape, people are despairing. And addiction does not come from pleasure seeking; it comes from pain.
AMY GOODMAN: Can you explain what naloxone is?
MAIA SZALAVITZ: Sure. It is the antidote to opioids. So, basically, if you take an opioid, it will create a high, and if you take naloxone, it will stop that. And if you have overdosed, that will save your life. I mean, it’s really a miracle drug. If you see somebody who is overdosed, they will be grey and not breathing and terrifying-looking. You give them this shot, and they are revived. They may not be especially happy, because if you give them too much, they’ll be in withdrawal. But they are alive, and, you know, dead people can’t recover. I think that naloxone should be in every first aid kit, because lots of people have opiates in the house. You never know. You should lock them up, but you never know if your teenager is going to develop a problem. You never know if somehow the toddler is going to get into something. You know, you want to have that there. And we need to destigmatize it so that people don’t think that like, "Oh, only drug addicts have that in the house." So I think, you know, it’s great, Obama expanding this more and more. But, you know, we need an ad campaign to say, "This should be in your first aid kit. Make it cheap. Make it available." That will save a lot of lives.
JUAN GONZÃLEZ: I want to turn to another clip from Tuesday’s National [Rx] Drug Abuse & Heroin Summit in Atlanta. The subject of access to naloxone was addressed several times. Baltimore City Health Commissioner Leana Wen was asked about it by the panel’s moderator, Sanjay Gupta.
DR. SANJAY GUPTA: You provided your own name as a doctor at all the pharmacies, I understand, in Baltimore or certain areas, so that anybody going in could get their Narcan, their naloxone, if they want it. Is that right?
DR. LEANA WEN: That’s right. So we issued a standing order in the city, which—we strongly believe that everyone should save a life. ... If it’s true that addiction does not discriminate—and it does not; if it’s true that anyone can die from overdose—and I’ve treated two-year-olds who have accidentally taken their parents’ medications, I’ve treated 75-year-olds who are on prescription drugs; I mean, if it’s true, then any of this disease can affect everyone. Then we should all be able to save a life. And so, I issued the standing order, and now anyone who takes a very short training—they can get a training on a street corner, public market, public housing, in jails—if they do a short training, they can get a prescription in my name. So, 620,000 residents of our city have access to naloxone.
DR. SANJAY GUPTA: Wow, that’s what a solution looks like, right?
JUAN GONZÃLEZ: Your response?
MAIA SZALAVITZ: I think that’s wonderful. We really need to have it available to everybody. I mean, one of the things—I went to my local pharmacy and asked for it, and it was kind of embarrassing. So I—
AMY GOODMAN: Why was it embarrassing?
MAIA SZALAVITZ: Well, I guess because of my past, which of course they didn’t know. But, you know, I was sort of joking, "Well, I’m not planning on overdosing any time soon." But we need to—that may be a barrier for some people, and we need to do that, need to figure out a way to make it so that people are not intimidated by asking for it. Otherwise, if they leave it out, it will get stolen, like condoms. So—but it felt very similar to that feeling. But I think that’s absolutely wonderful.
And one of the biggest misunderstandings we have about addiction is that tough love—is that being kind will fail and tough love will work. What really helps and why harm reduction, which is this idea that we will meet you where you’re at and we’ll help you whether you’re ready to stop or not—why that works is because when you have addiction, you tend to be very marginalized, self-hating. You might be homeless. You feel like a criminal. Nobody has any respect for you. And when somebody just hands you a clean needle or gives you access to naloxone and says, "I believe you deserve to live, regardless of whether you do what I want," that’s a really powerful message of kindness. And I’ve seen it. I’ve been out on the street with needle exchangers. And you see these homeless people who are like—you know, they’re hidden behind this mask of despair. And they have a real human interaction with somebody, and they start to think, "Wow, somebody values me. Maybe I should value me. And maybe I can do this someday and help other people." So it’s a really almost spiritual thing.
AMY GOODMAN: In the first part of our discussion, we touched on different places that are pioneering ways to deal with addiction. I recently moderated a panel where we had the mayor of a major city and a police commissioner, all who originally had been opposed—this is all over the world—to having, for example, safe injection sites, where it was legal for someone to go into a place and actually inject, who ended up completely turning around, across the board, across the world, when they saw that addiction went down, crime went down. Explain. What are some of these places, from Vancouver to, I think it was, New Zealand?
MAIA SZALAVITZ: Yes, yes. So, in Vancouver is the first safe injection facility in North America. They have them in a bunch of places in Europe. Portugal is a really interesting place, because they have completely decriminalized drug possession. And we really need to do that. There is absolutely no reason that putting somebody in jail solves anything in terms of a drug problem.
AMY GOODMAN: Well, they’ll say it gets rid of the drug dealer, so that their kid can’t—won’t be exposed.
MAIA SZALAVITZ: Except, of course, that there is—for every drug dealer you get rid of, there’s 10 waiting in the shadows, because the demand is there. And as long as the demand is there—and the demand is going to be there as long as human beings exist, unfortunately—we need to recognize that, you know, people sort of have a natural desire to alter their consciousness. And we can either pretend that that is not true and ignore it and allow a lot of people to be killed by gangsters because of that, or we can accept it and try to find the least risky substances and steer people towards them. I mean, our drug policy, from the very beginning, has been based on racism. The only reason we have alcohol and tobacco legal and the rest of the drugs illegal is racism. It has nothing to do with science. I mean, if you were scientifically going to choose a drug to make legal, cigarettes would be the absolute last thing you would choose. They actually kill 50 percent of their users. I mean, you know, you could—the FDA could approve anything under those standards.
AMY GOODMAN: So, what you think would be the most important move right now, where the United States is, given where it is, to deal with the issue of addiction?
MAIA SZALAVITZ: Sorry, yes, I do think that we should decriminalize all possession of all drugs. I do think we should move forward, as the states are moving forward, with marijuana legalization. Marijuana is one of the least harmful. It’s not nonharmful, but it is the least harmful. And if—you know, there are studies suggesting that people often switch from opioids to marijuana either for pain or for addiction. And if that happens, that’s a win all around. I mean, you talk to any of these moms who have lost kids or who have kids who are struggling and tell them, you know, "Would you want your kid to stay on opioids or be on marijuana?" they would pick marijuana by 99.9 percent there. You know, and so, there’s actually studies showing that there is lower overdose rates in the medical marijuana states. So, we need to create a more compassionate and loving drug policy. And nobody is going to believe that addiction is a disease as long as the behavior is criminal.
AMY GOODMAN: Well, I want to thank you so much for being with us. Maia Szalavitz is a journalist who’s covered addiction for almost 30 years. Her new book is Unbroken Brain: A Revolutionary New Way of Understanding Addiction. I’m Amy Goodman, with Juan GonzÃ¡lez. If you want to see Part 1 of our conversation, go to democracynow.org.