What Causes Addiction?
In an increasingly widely disseminated TED Talk titled “Everything You Think You Know About Addiction is Wrong,” British journalist Johann Hari discusses the available research into the underlying causes of addiction and concludes, rather brilliantly, that the opposite of addiction is not sobriety, it’s connection. His statement echoes a theme that I and many 21st Century addiction specialists have espoused for years — that addiction is not about the pleasurable effects of substances, it’s about the user’s inability to connect in healthy ways with other human beings. In other words, addiction is not a substance disorder, it’s a social disorder.
This, of course, is contrary to what most folks believe about substance abuse. In general, people think that the pleasurable effects of alcohol, cocaine, heroin, and the like are the primary drivers of addiction. And why not? We know for certain that once ingested these substances trigger the release of dopamine and several other pleasure-related neurochemicals into the brain. In other words, potentially addictive substances make us feel good, and because we like to feel good, we tend to go back for more. Hence, the human propensity for addiction. Or so it seems at first glance. Bolstering this belief is the fact that most of the early research and theories on the root causes of addiction are centered on the brain’s pleasure response — the aforementioned dopamine rush. Even the National Institute on Drug Abuse initially espoused this view.[i]
Nevertheless, this long-held belief is incorrect. If it wasn’t, then everybody who ever took a sip of alcohol would become a raging drunk, and everyone who ever ingested an opiate (even via prescription) would end up in a back alley shooting heroin. But that isn’t even close to what actually happens. In reality, only about 10 percent of the people who try a potentially addictive substance eventually become addicted. The rest of the people either walk away from the substance completely or continue to enjoy it casually or recreationally.
Welcome to the Rat Park
Given the above, one wonders what is really going on with addiction. Obviously, there is more to the equation than just the dopamine pleasure response. Certainly the experience of pleasure does play some role, because it opens the doorway to addiction. But it is clear, based on the fact that most people do not become addicts, that over time a person’s initial experience of pleasure is not what causes that individual to return to an addictive substance again and again, compulsively and to his or her detriment.
This is a conundrum that scientists began to explore in the late-1970s and early-1980s. For instance, Canadian psychologist Bruce Alexander looked at the results of studies in which rats were placed in empty cages, alone, with two water bottles to choose from — one with pure water, the other with heroin-infused water. Those experiments showed that as time passed these rats would uniformly get hooked on and eventually overdose from heroin. So the researchers unsurprisingly concluded that the potential of extreme pleasure, in and of itself, is addictive. Case closed, right?
Not for Alexander. He was bothered by the fact that the cages in which the rats were isolated were small, with no potential for stimulation beyond the heroin. Alexander thought: Of course they all got high. What else were they supposed to do? In response to this perceived shortcoming, Alexander created what we now call “the rat park,” a cage approximately 200 times larger than the typical isolation cage, with Hamster wheels and multi-colored balls to play with, plenty of tasty food to eat, and spaces for mating and raising litters.[ii] And he put not one rat, but 20 rats (of both genders) into the cage. Then, and only then, did he mirror the old experiments, offering one bottle of pure water and one bottle of heroin water. And guess what? The rats ignored the heroin. They were much more interested in typical communal rat activities such as playing, fighting, eating, and mating. Essentially, with a little bit of social stimulation and connection, addiction disappeared. Heck, even rats who’d previously been isolated and sucking on the heroin water left it alone once they were introduced to the rat park.
The Human Rat Park
One of the reasons that rats are routinely used in psychological experiments is that they are social creatures in many of the same ways that humans are social creatures. They need stimulation, company, play, drama, sex, and interaction to stay happy. Humans, however, add an extra layer to this equation. We need to be able to trust and to emotionally attach.
This human need for trust and attachment was initially studied and developed as a psychological construct in the 1950s, when John Bowlby tracked the reactions of small children when they were separated from their parents.[iii] In a nutshell, he found that infants, toddlers, and young children have an extensive need for safe and reliable caregivers. If children have that, they tend to be happy in childhood and well-adjusted (emotionally healthy) later in life. If children don’t have that, it’s a very different story. In other words, it is clear from Bowlby’s work and the work of later researchers that the level and caliber of trust and connection experienced in early childhood carries forth into adulthood. Those who experience secure attachment as infants, toddlers, and small children nearly always carry that with them into adulthood, and they are naturally able to trust and connect in healthy ways. Meanwhile, those who don’t experience secure early-life attachment tend to struggle with trust and connection later in life. In other words, securely attached individuals tend to feel comfortable in and to enjoy the human rat park, while insecurely attached people typically struggle to fit in and connect.
Guess which group is more vulnerable to addiction?
The good news is that people with insecure attachment styles are not locked into this approach for life. With proper guidance and a fair amount of conscious effort the individuals who were not graced with secure attachment in childhood (and therefore the ability to easily connect in adulthood) can learn to securely attach — usually through therapy, support groups, and various other healthy and healing relationships — creating over time what is known as “earned security.”
For human addicts, earned security is a very important concept. Rats don’t really need it. You can take an addicted rat and toss him into the rat park and he will quickly and easily assimilate, pushing his addiction to the curb in favor of healthier rat connections and activities. But people? Not so much. With human addicts there is further work to be done, and part of that work nearly always involves overcoming the lack of trust and connection created in childhood.
Interestingly, both AA and the addiction treatment community as a whole realized this fact long before Alexander’s rat park experiment. In truth, the often parallel work of 12-step recovery programs and formalized addiction treatment programs — after the initial experience of detox — involves connecting the addict to other people. And not just any people, either. We’re talking about safe, supportive, reliable, empathetic people.
Much of the time these safe and supportive people are other addicts in recovery who know exactly what it feels like to be addicted and to embark on the lengthy process of healing. However, this newfound sense of connection doesn’t always have to be with other recovering addicts. For instance, as Hari discusses in his TED Talk, the nation of Portugal, which decriminalized illicit substances (i.e., addictive drugs) in 2001, takes a broader-than-normal approach to overcoming addiction. Instead of spending money on incarceration, Portugal has focused its efforts on helping addicts connect with society at large. If, for instance, an addict was a computer programmer prior to his or her downfall, the government will find a company that needs a computer programmer and offer to pay half of the addict’s salary for the first year of employment if the company will give that person a shot. Additionally, the government funds traditional treatment opportunities and various other forms of social support. In short, Portugal tries to reintegrate addicts into the human rat park in a way that helps them learn to trust and connect.
And it’s working, too. Contrary to most doomsayer predictions, decriminalization in Portugal did not lead to an increase in drug use, addiction, and related problems. In fact, the opposite occurred. Problematic drug use is down, drug use among adolescents is down, drug related deaths and other drug related harms are down, jail/prison overcrowding is down, etc.[iv] That said, things are not perfect. For instance, there are reports that cannabis use is up, and that more people are reporting lifetime usage of it.[v] (This may be a matter of people equating marijuana with alcohol, and, now that it’s legal, simply preferring to smoke rather than drink.) But overall it looks like Portugal’s unprecedented strategy of connecting rather than isolating problem drug users has been effective.
So it does indeed appear that the opposite of addiction is not sobriety, it’s connection. That said, developing healthy interpersonal connections as a part of recovery and healing is not easy. It takes time, effort, and a willing support network. The good news is that we now know for certain that this type of recovery and social connection is possible — even for the most problematic of addicts.
Robert Weiss LCSW, CSAT-S is Senior Vice President of National Clinical Development for Elements Behavioral Health. In this capacity, he has established and overseen addiction and mental health treatment programs for more than a dozen high-end treatment facilities including Promises Treatment Centers in Malibu and Los Angeles, The Ranch in rural Tennessee, and The Right Step in Texas. An internationally acknowledged clinician and author, he has served as a subject expert on the intersection of human intimacy and addiction for multiple media outlets including The Oprah Winfrey Network, The New York Times, The Los Angeles Times, The Daily Beast, and CNN, among many others. He is the author of several highly regarded books on intimacy and addiction. For more information, please visit website, robertweissmsw.com.
[i] Bejerot, N. (1980). Addiction to pleasure: a biological and social-psychological theory of addiction. NIDA research monograph, 30, 246.
[ii] Alexander, B. K., Beyerstein, B. L., Hadaway, P. F., & Coambs, R. B. (1981). Effect of early and later colony housing on oral ingestion of morphine in rats. Pharmacology Biochemistry and Behavior, 15(4), 571-576.
[iii] Bretherton, I. (1992). The origins of attachment theory: John Bowlby and Mary Ainsworth. Developmental psychology, 28(5), 759.
[iv] Hughes, C. E., & Stevens, A. (2010). What can we learn from the Portuguese decriminalization of illicit drugs?. British Journal of Criminology, azq083.
[v] Hughes, C. E., & Stevens, A. (2007). The effects of decriminalization of drug use in Portugal.