Review: ‘Unbroken Brain’ Author Made My Life Make More Sense
By Kirk Klocke
As the old saying goes, if you’ve met one autistic person – you’ve met one autistic person. Maia Szalavitz, the New York Times best selling author of “Unbroken Brain: A Revolutionary Way of Understanding Addiction” and former heroin and cocaine user, got a nice laugh at her book talk Wednesday, May 8 in Minneapolis. Her point was this: People’s paths into harmful addiction is wide and varied – and so are their paths back into productive, happy lives.
What is confounding and endlessly frustrating for those of us who are actively suffering, or have in the past, is that despite overwhelming new evidence that our society’s treatment model doesn’t work, we keep hitting our heads against the same wall. Same results, but skyrocketing costs year over year. Poor people receive punishment. Wealthy, mostly white people land in comfy treatment facilities sitting in circles talking about feelings while collecting a paycheck from their employer’s short-term disability plan.
A fortunate few land somewhere that truly treats addiction as a medical illness, using evidence-based medication-assisted and talk therapies tailored to the patient’s unique needs. Szalavitz’ book briefly reviews the historical driver behind addiction stigma: racism. People who remind people of themselves (middle class white people) are ill and need time and medical care to heal. People of color (the ‘other’) struggling with the exact same thing, albeit perhaps with a different substance that is either cheaper or otherwise more accessible in their community, are somehow scary and harmful – and need to be locked away. We’ve made a bit of progress in this area, Szalavitz says, but since her own using days in the mid- to late-80’s, not much.
So, the addiction treatment world in the U.S. is at a crossroads. A lot of people stand to lose a lot of money if we break from the status quo and side with medical evidence. Jails and prisons would lose regular customers, and the myriad of contractors that serve our private system of incarceration would also lose big. They range from wire transfer services and bail bonds to manufacturers of cheap frozen cafeteria food and indestructible furniture. And although there are many idealistic, well-meaning young counselors in on the ground level of the treatment world, overall it is a scummy overpriced industry that is possibly the biggest taxpayer funded sham in history.
My cynicism doesn’t come just from news stories about people dying shortly after being discharged from their so-called treatment program or the latest sober housing slumlord scandal in Denver, New York, Fort Lauderdale, or wherever else. It comes from seeing firsthand how treatment center administrators pressure counselors to manipulate observation notes in favor of keeping clients as long as their insurance carriers and county funding programs will possibly pay. Evidence says the longer the better! Those admins preach, appealing to idealistic do-gooder-ness, helping them with the moral gymnastics it takes to not feel bad about fudging the paperwork. The seemingly endless scam continues up and down the continuum of care levels via reciprocal referrals, which are backhanded kickbacks. It all takes place at the expense of taxpayers, insurers, and most importantly, the patients themselves, who usually have either the vulnerability of homelessness or being incarcerated for lack of compliance, thus completely at the mercy of a top-down corrupt system. It’s a system with a 1-year success rate of <10-percent, about the same as if the patient were out in the world on their own with no intervention at all.
Massive public and private funds flow into this boondoggle with virtually no accountability for independently verifiable results. Treatment facilities conduct surveys but fail to account for the obvious: No addict in active addiction answers his or her phone – ever. And they don’t live in any one place long enough to get a survey via mail. But the facilities presume no news is good news, which may be true in other areas of medicine, but not addiction, because all the system really does is teach people to be better at lying and hiding. Ask anyone who was in treatment a year ago how many of their peers remained sober, and you’ll get a much better idea of the truth. If this were any other medical illness, Szalavitz points out, such outcomes would be utterly unacceptable.
The $100 Billion a year treatment-industrial complex (not even counting jails, prisons, and local court systems) has a lot of momentum in one direction, and throwing even more money at it in the wake of this most recent spate of opioid deaths is politically expedient, so meaningful change in the way Szalavitz envisions is still a long way away. The advent of Alcoholics Anonymous during and immediately after Prohibition was a good start, because before that there wasn’t much of anything other than ‘go to more church.’ And Szalavitz is quick to say she is not against 12-step models of addiction recovery. It’s just that they don’t work unless the participant goes willingly and identifies with one of those programs as a community that is their community, she says. AA’s “spiritual experience” translated into agnostic terms means reconnecting with other human beings. After all, addiction is love gone awry, Szalavitz reminds us.
When I discovered Szalavitz’ work, I felt less alone in the world, and a new glimmer of hope about the whole situation. She validated what I knew about myself all along: I did what I did to cope, because I couldn’t – and to some degree, still cannot – find love and connection. Even the most introverted among us are still pack animals and will suffer from anxiety and depression if we can’t connect with others. What then happens to us misfits with a love deficit is one of two things: We’ll either seek power and control, or escape and numbness. The people who gravitate toward power and control often have some combination of sex, gambling, stimulant use, and workaholism that may at first make them seem charismatic and exciting, and they might quickly rise through the ranks in finance, medicine, elite fine dining, or law before hitting rock bottom. The ones who seek escape often have a genetic predisposition for anxiety – a heightened stress response activated by actual trauma or scarcity within three generations their senior in their family of origin. If they also have organic social difficulties, as I did – and as Maia Szalavitz did – it becomes a perfect storm for the onset of addiction in one’s teens and early 20’s. “We can often predict as early as preschool who is at a higher risk for addiction,” Szalavitz said at her talk this week.
Under her reimagining of addiction as more of a neurodivergence like autism, Asperger’s, and ADHD than a disease like cancer or diabetes, the illness takes root far before one’s first encounter with a mood-altering substance. A person must have both genetic vulnerability and environmental triggers that when combined, present as barriers to experiencing love and connection like normal people do. Making matters even more complex, environmental trauma doesn’t have to be directly experienced in the addicted person’s formative life. A father or grandfather exposed to severe trauma, be it war or poverty or crime, will pass down extra activated stress genes, which don’t again become dormant until about the third or fourth generation. This rapidly emerging field of epigenetics also often shows that such a heightened stress response often skips a generation, readily explaining why it is so common for addicts to have at least one parent who doesn’t have an addiction – an anomaly those in favor of calling it a choice and a moral failure have cited. He came from such a good family. Too bad he fell so far from the tree. But no. That’s not how it works.
Having a non-verbal learning disorder, a neurodivergence on the periphery of autism spectrum disorders, I identified deeply with Szalavitz’ experience. Her childhood quirks were a little different, but a few of them strikingly similar to mine. She had far superior verbal abilities and preferred to live in an inner world of science and fantasy rather than play with other kids. She could recite entire families of organic chemicals and knew most of the periodic table of elements. My jam was semi-precious stones and electrical engineering components, like capacitors, transistors, diodes, resistors, and oscillators. That was first grade. A time when most kids are more interested in running, chasing, pushing, hiding, and jumping around. And striking up a conversation about the nuances of capacitance in various dielectric materials isn’t typically a way to score new friends in the cafeteria in second grade.
Like a lot of kids on the autism spectrum, Szalavitz didn’t like strong stimulation not in her control, like bright sunlight, sudden loud noises, and loud music.
Being too intelligent for your age might sound like a blessing, but for children it’s a source of trauma, isolation, and confusion. As a kid, it’s both weird and not cool. As an adult, it’s cool, but still weird, leaving you with an extremely slim pool of potential mates and friends, leading to more painful isolation. By then, then the onset of seeking refuge in the warm, fuzzy chemical shelter of addiction is well underway, further driving the cycle of loneliness and isolation, involuntary celibacy, and depression. No healthy and highly intelligent person who would otherwise be our peer wants to date a drunk or a drug addict in the desperate throws of their problem.
This is where Szalavitz’ learning disorder hypothesis comes into play. She lays out a very convincing argument that drugs and alcohol are not the cause of addiction. Lots of people try drugs, and the great majority of them never develop a problem. The ones who do develop a problem do so because through repeated experimentation, they learn than taking the drink or the drug provides relief from their emotional suffering. Since 90 percent of addictions begin before age 25, when the brain is still developing, this use-relief pattern is deeply engraved in a multi-year learning process.
What the pro- disease model folks would have you believe is that treatment – most often harsh treatment – is what is required to help the patient un-learn their addiction and develop a new healthy way of living. This idea has been the basis for the massive prison-treatment industrial complex that is so enmeshed with our criminal justice and healthcare systems. Where Szalavitz’ learning model of addiction parts ways with the disease model is acknowledging that every person with a substance use disorder is different, just like every person with an autism spectrum disorder is different. Treating them all the same, and trying to “treat an illness that is defined by its resistance to negative consequences – with punishment,” as she says, is the worst possible thing society can do. Make no mistake, compelling people into treatment as a condition for helping them with their basic needs of housing, food, and medical care is a form of punishment. More than that, there is emerging evidence that most people who have a substance use disorder at some point in their lives simply outgrow it, whether or not they had a treatment intervention. Between 10 and 20 years after the onset of drug and alcohol use (with the exception of cigarettes), remission rates rise to over 90 percent and remain there for the remainder of people’s lives.
In a nutshell, our current system of “treatments” makes virtually no difference in addiction-related mortality rates, especially among opioid users. People who are going to die still die, and people who make it end up making it, regardless of how much or how little contact they’ve had with the current treatment model.
However, there are now more and more exceptions, and this is why Maia Szalavitz’ book is the John Barleycorn of the 21st century: The lucky few who actually get evidence based care – which includes supportive housing that is not tied to a patient’s sobriety status, medication assisted therapy, individualized counseling (but only if the individual wants counseling), and community support groups (again, only if the person wants to engage in them) – actually have better outcomes. Evidence-based treatment actually saves lives, and costs insurers and taxpayers a lot less in both the short- and long-run.
Her findings have turned out to be true across the board in my life. I’ve been through the ringer with all sorts of sitting around in a circle with assorted random addicts with whom I have nothing in common type treatments, and none of that made a dent in my problem. In fact, those experience made my problem worse, because I emerged with burning and anger and resentment at being pigeon-holed as exactly the same, rather than unique.
Finally, here’s what did work:
1.) Having a stable place to live
2.) Getting the meds sorted out by a professional
3.) Healthy eating and regular exercise
4.) Moving to a community where I have access to meaningful social and professional opportunity.
5.) Engaging in meaningful activity with people who are my creative and intellectual peers
Everyone’s solution is different. What worked for me probably won’t work for you.
That’s it. Not religious nonsense. Not punishment / having good things taken away. Not superstitious rituals. Not guilt and shame. Not talk therapy. Not group therapy. Not jail. And most of all, definitely not treatment programs that treat people suffering from a substance use disorder as if they’re all the same.
Unbroken Brain is validating and helped affirm that I’m not crazy. The system is. It is the first thing to really make sense following years of nonsense. I would recommend it with all my heart to anyone who is still suffering or knows someone who is. ♦
*editors note: John Barleycorn, a reference to a British folk song, is a 1913 autobiographical novel written by Jack London. It is loosely based on his personal struggles with alcoholism. London died in 1916 of complications of his illness.