Drug Addiction Is a Learning Disorder, says Maia Szalavitz | Big Think

Addiction is compulsive behavior despite negative consequences.

And it's really important to start by defining addiction because for a long time we really defined it very poorly. We used to think that addiction was needing a substance to function. And what that resulted in was that cocaine was not addictive because cocaine does not produce physical withdrawal that is noticeable. You may be cranky and irritable and crave cocaine, but you won't be puking and shaking and have the classic symptoms that you would see with alcohol or heroin withdrawal. So cocaine wasn't addictive.

Then crack came and we realized that defining addiction in that way not only harms people by telling them that cocaine is not addictive, it also harmed pain patients because people who take opioids daily for pain will develop physical dependence but they are not addicted unless they have compulsive behavior despite negative consequences.

I see addiction as a learning disorder, and the reason that I see it that way is because the biology of addiction unfolds in a developmental context over time, and that means that a huge amount of variables come into it, not only genes and early environment, but also culture, your family, the way you interpret your own experience. So it becomes very complicated pretty quickly.

Addiction is a learning disorder because it can't occur without learning. You have to learn to associate the drug with some kind of relief or pleasure. And you need to do that repeatedly over time before you can become addicted. This is why a baby can't be addicted because a baby who is born with physical dependence on something like heroin doesn't know whether it needs a diaper change or just wants mommy or wants heroin. And it certainly can't go out and score despite negative consequences.

So that's another reason what that it's really important to distinguish between physical dependence and addiction. So the learning is involved where you learn that this works to fix a problem, and you basically then fall in love with the substance. And once you've fallen in love with somebody or something, you will persist despite negative consequences in order to sustain that relationship because the biology is going to tell you that your life depends on this.

It basically acts in the brain region that is involved in survival and reproduction, and those are the two fundamental purposes of biology. So that creates really, really strong cravings, and it changes your priorities tremendously. And we don't really think about that when somebody falls in love and gets married and has a kid; we think that's very normal. And it is very normal.

But if you notice how people behave around love affairs, whether licit or illicit, they will tend to put that first, and they will do things that they might not otherwise do in pursuit of that. And you can certainly see that when people have affairs where they will lie, et cetera.

It's both. In order to overcome addiction, you need to figure out what purpose the addiction was serving. In my case, I had a lot of depression and I had a lot of difficulties connecting with people. I was also sort of overwhelmed by my senses and emotions a lot of the time, and opioids turned that down very nicely. So I needed to sort of figure out what was up and deal with those issues in order to be healthy and comfortable in recovery.

And that's going to be different for different people because they are going to have different issues that they are medicating with the drugs. I think psychedelics may be very useful in the treatment of addiction, but they are certainly not a cure. I think it's very important to keep in mind that insight alone does not change behavior.

And with the drugs like ibogaine, which seems to help relieve opioid withdrawal, it's all well and good if you have a trip and then you are no longer physically dependent on the drug. But if you then go back to the same environment and you haven't made changes that are going to allow you to cope in a different way, you will probably relapse and end up back in the same situation. So while it co...