10 Highlights From Johann Hari's "Everything You Think You Know About Addiction Is Wrong" (TED Talk Review)

"The opposite of addiction is not sobriety. The opposite of addiction is connection." A hundred years into drug prohibition, British-Swiss journalist Johann Hari, who grew up in a family of addicts, trots the globe in search of answers.

Do mongeese enjoy hallucinogens? Yes, Hari asserts, but only under certain circumstances. Trippy photo from Boing Boing.

YouTube link to the talk here.

Hari's talk is short and powerful; anyone who loves an addict should listen to it. I thought I'd share some of my takeaways.

1. Addicts are born, not made. Addicts and alcoholics are addicts and alcoholics before we ever take a drug or drink a sip of alcohol. This wisdom, often repeated in the rooms, is frequently misconstrued. What we mean is that - in addition to running in families due to a strong genetic component - there are personality traits and tendencies that all addicts share that manifest before our drugs of choice enter the picture and persist long after abstinence from substances is achieved. Emotional dysregulation; tendencies toward compartmentalization, perfectionism, and obsession; and selfishness / self-absorption, loneliness / isolation, and difficulty connecting with others on the deepest levels (bonding) are a few. The way that I explain this is by saying that for me, taking opioids didn't feel like adding something to my neurochemistry; it felt like correcting something, like completion. Like I was finally the person I was meant to be. It was that sensation of someone rubbing your back and relieving a deep knot in your muscles, which you didn't even realize was there carrying all of your tension.
   

2. Addiction isn't a "choice," even in the beginning, in that A) most of us are exposed to alcohol and other drugs of abuse so early on in life, long before our executive decision-making has matured enough to appreciate the risks that we are taking, and B) addiction commandeers the reward circuitry of the brain and erodes the very neural networks that would allow us to step back, recognize a behavioral pattern that isn't working for us, and change it. Almost all of us are exposed to a drug of abuse in a social or medical setting at least once in our lives, whether it is after wisdom tooth removal or in a club for our 21st birthdays. The vast majority of people return to sobriety afterward with something like gratitude. For addicts and alcoholics, by contrast, a seed has been germinated, and a deadly weed begins to grow.
   

3. The Rat Park experiments demonstrate the relationship between isolation and addiction. Hari reviews Canadian psychologist Bruce Alexander's Rat Park experiments, which provided evidence that properly socialized and stimulated rats failed to become addicted to heroin and cocaine even following extended exposure under conditions of unlimited use. On the other hand, rats kept in isolated and stressful conditions almost invariably began compulsive use, which often led to overdose. Addiction is an expedient solution to psychological and social/familial imbalances whose deadly cost doesn't register until it is too late. It has less to do with substances and more to do with psychosocial circumstances.
   

4. The experience of Vietnam War vets shows that, without an addictive predisposition, even "hard drug" use doesn't lead to addiction. Hari references the Vietnam War example that I mention at the beginning of my post on geographical change as an aid to recovery. In the U.S., the Archives of General Psychiatry's robust dataset revealed that of the 20% of U.S. soldiers who used heroin regularly doing their tours of duty in Vietnam, 95% of them came home and left the drug behind - many without experiencing the hellish withdrawal syndrome of Trainspotting fame. Why? They became dependent on heroin in nightmarish circumstances; when they left those circumstances behind, the great majority of them lacked the addictive predisposition necessary to continue using in a healthier, balanced environment.
   

5. Prohibition doesn't work because it increases stress and isolation through criminalization and stigmatization. In fact, it exacerbates nearly every facet of addiction. Addicts need especially strong social networks to stay healthy, and prohibition precludes addicts' participation in society on many levels. This worsens people's natural aversion to dealing with active addicts: Everyone loves to have a recovered addict as a shining example of a friend, but few people want to be bothered by rambling phone calls and other erratic behavior from relapsed addicts - who are exactly the people most in need of support.
   

6. Portugal's 21st-century policy shift demonstrates that decriminalization of drug use works. In 2000, a shocking one percent of people in Portugal were addicted to heroin. Faced with the failure of the punitive War on Drugs model, Portuguese leaders conducted a review of evidence that led to decriminalization of all drugs. Then, they used the money that would've been put toward prosecution and incarceration to fund programs that reconnected addicts with society, such as microloans for small businesses (in addition to offering residential treatment and other standard medical interventions). Everyone needs something to get out of bed for in the morning ("ikigai" in Japanese). Fifteen years later, Portugal's program has been a success by every metric - decreased addiction rates, relapse rates, HIV / Hep B and C infection levels, overdoses, and so on.
   

7. The common thread of all addictions - from food to sex to gambling - is engaging in compulsive behavior in place of connecting / bonding with others in healthier ways.* A huge component of bonding, in turn, is developing a network of responsibilities to others. In this light, 12-Step programs' insistence on immediately being of service to others as a newcomer, even if it's just by committing to making the coffee for the meeting once per week, checks out. *Technology and modern life in general have made true human connection IRL an increasingly rare commodity, which partly explains the drastic increases in rates of advanced addiction during the 21st century. As Hari puts it, "We are one of the loneliest societies there has ever been."
   

8. When 12-Step programs work, it's because they promote bonding. To expand on (7), I have long believed that most of the efficacy of 12-Step programs comes from their social component; in other words, if you removed the 12 Steps and simply rebranded these programs as intensive peer support with mentorship, most of the (not particularly statistically impressive, from what we can tell) benefits would remain. Hari's view on addiction substantiates this, as do the datasets that he developed it using.
   

9. Punishment and shame drive addiction. Most people can appreciate that a bipolar person in the grip of a manic episode might behave oddly because he is not fully in possession of his faculties; despite all of the neuroscientific evidence, however, they will not extend the same kindness to an addict in the midst of a cocaine binge, who goes for days without sleeping and drains his / her bank account to the last cent. I suppose this is partly because of the perception that the addict / alcoholic is getting something "pleasurable" out of his or her faulty wiring, although anyone acquainted with the hell of regular substance abuse will understand that the initial pleasures dissipate very quickly as addiction sets in.
   

10. Sit with us. Hari affirms the pain and frustration of connecting with struggling addicts. His solution is as beautiful as it is simple and powerful: "...to say to the addicts in my life, I want to deepen my connection with you. I love you whether you're using or not, no matter what state you're in, and if you need me, I'll come sit with you." Thank you to everyone who has ever sat with me. I am still alive because of you. I've changed the settings so that you should be able to comment below without registering. I'm eager to hear what everyone thinks of this talk. If you're interested in an in-depth elucidation of Hari's views on addiction, he wrote a book called Chasing the Scream.