The Globalization of Addiction: A Study in Poverty of the Spirit

"Bruce Alexander is a person I’ve got to know pretty well. I think he’s an extraordinary man, with an extraordinary mind. He really educated me, and transformed how I think about this. If you had said to me four years ago, ‘What causes heroin addiction?’ I would have looked at you as if you were a bit simple-minded, and said, ‘Heroin causes heroin addiction.’ We’ve been told that story about addiction for 100 years and we take it for granted as common sense. Certainly I did. We think that if you, me and the first 20 people to read this article all used heroin together for 20 days, on day 21, we’d all be heroin addicts because there are chemical hooks in the drug that our body would physically need at the end of it. That’s what addiction means. The first thing that alerted me to the fact that that might be wrong is when it was explained to me like this: If, at the end of this interview, I step out onto the street and am hit by a car, and am taken to hospital with a broken hip, it’s quite likely I’d be given diamorphine, which is medically pure heroin. It’s much stronger than anything you’d ever get on the streets because it’s not contaminated by dealers. And it’s possible that I’ll be given it for a quite a long period of time. For anyone reading this in the developed world, there are people in hospitals near you being given a lot of heroin right now. If what we believe about addiction is right, what would happen to those people? Some of them, at least, would become addicts. They would leave and want to score on the street. That virtually never happens. That seemed so weird to me, that I didn’t know what to do with it until I read, and then interviewed extensively, Bruce Alexander. Bruce explained to me that the ‘common sense’ view of addiction we have comes from a series of experiments that were done earlier in the twentieth century. They’re really simple experiments, readers can do them at home if they’re feeling a bit sadistic. You get a rat and put it in a cage and you give it two water bottles. One is just water, and one is water laced with either heroin or cocaine. If you do that, the rat will almost always prefer the drugged water and almost always kill itself. That’s our theory of addiction. Bruce comes along in the 1970s and says, ‘Hang on, we’re putting the rat in an empty cage, it’s got nothing to do except use this drug. Let’s do this differently.’ So he built Rat Park. Rat Park is a cage that is like heaven for rats, it’s got loads of nice food, coloured balls, tunnels, and, crucially, loads of other rats: loads of friends, the rat can have loads of sex, whatever it wants. Again, they’ve got the water bottles: the normal water and the drugged water. But here’s the fascinating thing: In Rat Park, the rats don’t like the drugged water, they hardly ever use it. None of them ever overdose, or use it in a way that looks compulsive or obsessive. There was a fascinating human parallel to Rat Park that was happening, by coincidence, at the same time. It was called the Vietnam War. 20% of troops in Vietnam were using heroin, and if we look at the news reports from the time, Americans were shitting themselves because they thought, ‘When the war’s over, we’re going to have hundreds of thousands of junkies on the streets of the United States.’ But studies that followed these troops discovered something really striking, which is that 95% of them just stopped when they got home. They didn’t go to rehab and they didn’t need any treatment. That doesn’t fit with the old theory of addiction, but, if you follow Bruce’s theory, it makes complete sense. If you’re taken out of a hellish pestilential jungle where you don’t want to be and could be shot at any moment, and go back to your nice life in Wichita, Kansas with your friends and family, will you want to be present in your life again? It’s the equivalent of being taken out of that first cage and put into Rat Park. You see this with lots of people who have addiction problems. If their lives can be turned around, if their environment can be radically improved, if they can be connected with sources of meaning, they don’t want to be out of it all the time. What Bruce says this shows is that both the right-wing and left-wing theories of addiction are wrong. The right-wing theory is it’s a moral failing, you’re a hedonist, you indulge yourself. The left-wing theory is your brain gets hijacked, you get taken over. Bruce says, it’s not your brain, it’s not your morality, to a much larger degree than we’ve appreciated until now, addiction is an adaptation to your environment. Professor Peter Cohen talks about how we shouldn’t even use the term ‘addiction,’ we should use the term ‘bonding.’ Human beings have an innate need to bond, and when we’re happy and healthy, we will bond with each other, we will connect with other human beings. When we can’t do that because we’re isolated, or beaten down, or traumatised, we will bond with something that gives us some sense of relief. That could be gambling, it could be pornography or cocaine. But we will bond with something that gives us a sense of meaning. Bruce’s book is a brilliant exposition of this, and there are huge implications. The implications for the drug war are obvious: we take people who are addicted because they’re isolated and traumatised, and then isolate and traumatise them further in the hope that it will make them stop. I went out in Arizona with a group of women who were made to go out on a chain gang wearing t-shirts saying ‘I was a drug addict’ and made to dig graves. This is an extreme example, but actually, all over the world — except in the places that have decriminalised, like Portugal, or legalised, like Switzerland — we take addicts and give them criminal records. We cut them off from society, and then we’re surprised that they don’t get better. Gabor Maté, who wrote the next book we’re going to talk about, said to me — I’m paraphrasing, the exact words are in my book — ‘If you wanted to design a system that would make addiction worse, you’d design the system we have now.’ I’m not saying that the chemical component of addiction plays no role: It does play a significant and real role, and we can actually measure how much and answer this. We can even measure it by looking at nicotine patches. In the early 90s, there was a broad scientific consensus that one of the most physically addictive drugs in our society is tobacco. We can isolate the physically addictive component in tobacco because we can test whether it causes withdrawal, and it’s nicotine. So, when nicotine patches were invented, there was a huge wave of optimism. People thought, ‘Ah great! We can give smokers the drug they’re addicted to without the filthy carcinogenic smoke. Brilliant!’ The U.S. Surgeon General conducted a very detailed study, and found that 17% of smokers with nicotine patches were able to stop, and the remaining 83% weren’t. Now, 17% is a lot, it shows you a significant component of the addiction is a physical addiction. If you can stop 17% of tobacco addiction, that’s a huge deal. But it still leaves 83% that can’t be explained through chemical means. Given that we know that tobacco is one of the most physically addictive drugs, we would expect it to be a similar or smaller percentage with other drugs. A very important person here is Dr Carl Hart, a professor at Columbia University , who I interviewed extensively. Even if you look at meth, or crack, the vast majority of people don’t become addicted. That was really shocking to me, but the evidence is pretty robust. 90% of drug use, even according to the UN Office on Drugs and Crime — the main drug war body in the world — is non-problematic. What we have to understand, and what Bruce and Gabor, the next person we’re going to talk about, are so good at explaining, is that for most of the 10% of people who are terribly damaged — and that includes people very close to me — the drug itself is not sufficient to explain the addiction. There are other aspects that are highly significant, and – crucially – they were there before the drug ever came along. The best way to explain it is like this: you’ve got a glass of water in front of you, I’ve got a sparkling grape juice. Forget the drug laws for a second. We could both be drinking vodka right now, totally legally. We’ve probably both got enough money that we could do nothing but drink vodka for the next three months. The reason we’re not doing it is not because anyone’s stopping us, it’s because we’ve got something we want to be present for in our lives. We’ve got jobs we love, we’ve got people we love, we’ve got books we want to read, we’ve got stuff we want to do. If you look at addicts — clearly it’s a complex picture and there’s many factors — but the single biggest factor, and I think Bruce has demonstrated this very powerfully, is that addicts are people who can’t bear to be present in their lives. If we want to change that, and there are countries that have changed that, we have to make their lives better, not worse. One thing we can say about the drug war is that we gave it a fair shot. We gave it 100 years and a trillion dollars. We can compare the results we got from that, to the results of countries where they’ve spent most of their money on turning addicts’ lives around. In Portugal, nearly 15 years ago, they decriminalised all drugs and spent the money on treatment for addicts, and turning addicts’ lives around, in particular through subsidised jobs. The results are that injecting drug users are down by 50%, overdoses are massively down, and HIV transmission among addicts is massively down. We can see how these models work, there’s nothing theoretical or abstract about this debate anymore, there are countries that have tried the prohibitionist approach, there are countries that have tried approaches based on compassion, and we can see the results. In 2000, Portugal had one of the worst drug problems in Europe. 1% of the population was addicted to heroin, which is mind-blowing. Every year they tried the American way more: they arrested more people, had more people in prison and the situation just got worse. One day the prime minister and the leader of the opposition got together and said, ‘We can’t go on like this, what can we do?’ So they set up a panel of scientists and doctors to figure out what would genuinely solve the problem. They agreed in advance that they would do whatever the scientists recommended, because it took it out of politics. The panel went away for a year-and-a-half and came back and said: Decriminalise all drugs, from cannabis to crack, but — and this is the crucial thing — take all the money we currently spend on arresting and imprisoning drug users, and spend it on the lessons of Rat Park. Let’s turn addicts lives around, let’s help them to reconnect. So, say you’re an addict who used to be a mechanic. They’ll go to a garage and say, ‘If you employ this guy for a year, we’ll pay half his wages,’ — just to make sure that every addict in Portugal had something to get out of bed for in the morning. 15 years later overall addiction is down, and one of the ways you know it succeeded is no one wants to go back. I interviewed João Figueira, who was the top drug cop in Portugal. He led the opposition to the decriminalisation. He said a lot of the things that people reading this will be thinking: ‘Surely it will be a disaster if you just decriminalise all drugs?’ He said to me words to the effect of: ‘Everything that I said would happen, didn’t happen, and everything the other side said would happen did.’ He talked about how he felt ashamed that he’d spent 20 years before the decriminalisation arresting and harassing drug users, and he hoped the whole world would follow Portugal’s example."