A New Look At Addiction

A New Look At Addiction

-by Dr. Richard Marshall

I took advantage of the extra time that the July 4^th holiday provided by first perusing the news. I’m glad I did, as I stumbled on a gem of an article about addiction in teens. It is beautifully written by Maia Szalavitz, a twenty something former addict and it appears in the June 25, 2016 issue of New York Times Sunday Review. I was initially attracted by the title, “Can You Get Over an Addiction.” We have a special interest in this topic, because we see many teenagers in our practice who are just beginning to use drugs and it is devilishly difficult to convince them to stop.

By the time I reached the third paragraph, I was hooked, because it is here that the writer explains that there are two schools of thought on addiction. The first is the addiction-as-disease model, that the brain gets “highjacked” by the drugs leaving us powerless to stop. The second is the addiction-as-a-moral-failing model, that is that drug addicts are “selfish criminals” who don’t care about anything or anyone but themselves. She then goes on to explain that neither model adequately explains drug use, abuse, and addiction—especially in teenagers.

Teen Substance Abuse

She rejects the disease model, because unlike dementia or cancer, addiction is neither pathological nor degenerative. As she rightly points out, over half of all addictions stop without treatment by about age 30. Something is going on in the brain prior to age 30, but it’s not a disease. She also rejects the “addiction as sin” model, because treatments based on this model are notoriously ineffective—and (as most parents already know) they are especially ineffective with teenagers who don’t see drugs as a moral issue. She also points out that addiction is the only condition that we treat with moralizing. We would never ask patients suffering from depression to first admit that they are weak, that they should apologize for their behavior, or that they should be punished for their condition.

Several years ago, I co-authored a book titled, The Middle School Mind: Growing Pains in Early Adolescent Brains. In it, we discuss the massive structural and chemical brain changes that occur with the onset of puberty. In a nutshell, the emotional structures in an adolescent’s brain (the things that control motivation, pleasure, and the brain’s reward system) are in overdrive, while the inhibitory mechanisms housed in the brain’s frontal lobe won’t mature until we reach our mid to late twenties. As a result, emotions overwhelm the teenager’s thinking, judgment, and their ability to inhibit. In a teenager’s brain, the possibility of a reward overrides everything else. The reason punishment doesn’t work very well with teens is that teenagers are more than willing to risk punishment if there is even the slightest chance of doing something that makes them feel good.

Szalavitz’s article provides valuable insights that could lead to more effective interventions. The first is to think of addiction as we think about romantic love. Being in love makes us feel good; it gives us a sense of well-being, a euphoria that we don’t want to ever give up. Most of us have felt the pain of a break-up. Eventually, of course, the pain subsides; but the initial pain feels unbearable and we will do just about anything to stop it and to have those good feelings back. This is a more accurate way, Szalavitz argues, to think about addiction. We will do anything to get rid of the cravings and to have those good feelings back again. Once the brain’s reward system has found something it likes, everything else, including the possibility of punishment, falls by the wayside.

Treating Addiction Like a Break-up

Think about it. What’s the advice we get from friends and family after a breakup? Move ahead by finding someone else; get your mind off it by doing something else. What are they telling us? Take charge of your life, find something else that is rewarding. The last thing we want to hear is that we have no control over our feelings, or that we should admit that we are weak, or that we have a moral failing, or that we should be punished.

Instead of thinking about addiction as a moral failing or as criminal activity, we should think about it as we think about other brain-based disorders such as ADHD or a reading disabilities. In these cases, we talk about the brain being wired differently. In the case of addiction, a person discovers a maladaptive way of coping with the challenges life throws our way. It is during adolescence when our children first discover that drugs provide a way to calm their super-charged and hyper-reactive nervous systems and to make life more manageable. Though warned about the dangers of illegal drug use, they are willing to risk whatever they must risk in order to feel the relief that drugs provide.

One of the differences between adults and teens is that adults seek treatment when they hit bottom, when they become aware that they are about to lose everything they value in the world. Unlike adults, teens have little or nothing to lose, so they are far less likely to feel the need to stop using and to get help to do so. And the last thing they want is to see a professional who is going to work with their parents to get them to stop using. They have just discovered something that makes them feel normal and they are not about to give it up and have all those negative feelings return. That’s why they resist treatment. They know we want to take something away and they get nothing in return. What this article tells us is that we do have something to offer in return.

The good news, of course, is that most teens are not going to become addicts. Most will experiment but decide drugs are not for them; others will use certain kinds of drugs in social settings. But if you suspect that your teen is using every day, or is using drugs to cope with life, or is self-medicating, we encourage you to seek professional help. Above all, don’t panic. There is work to do and it will take time and patience. What we have to do is to take the compulsive drive that sustains addiction and direct it into healthier channels—just like we do after a break up.