UNBROKEN BRAIN

Nonfiction
Not a failure of the will

UNBROKEN BRAIN:
A Revolutionary New Way of Understanding Addiction
By Maia Szalavitz
336 pp. Da Capo

Reviewed by David E. Hoekenga, M. D.

This book indeed shows a new way to look at drug addiction. The author herself survived a long addiction to several dangerous drugs, and she claims that a learning disorder causes addiction – not a genetic abnormality, weakness of character, or a lack of will power.

“I was sitting on the edge of Jerry Garcia’s bed in a nondescript and surprisingly unluxurious hotel room in New Haven,” she writes, “when he offered me a line of cocaine. I was 17; it was 1982. ‘Cocaine has some very some very weird karma behind it,’ Garcia told me in his fatherly nasal speaking voice. On coke I felt a smug sense of superiority, of being in on something, of being powerful and utterly desirable.”

She also marshals an immense number of facts about “substance abuse.” For example, at least half of addicts have other serious mental disorders such as depression, anxiety, bipolar conditions, ADHD and schizophrenia or Asperger’s syndrome. Adolescence is a very high-risk period for addiction because the brain is changing rapidly for adult sexuality and responsibility. Even though blacks and Hispanics are no more likely than whites to become addicts, Szalavitz writes, those with dark skin are more likely to be depicted in stories about addiction. This gives readers a false impression. Also, people with high I.Q.’s are associated with higher rates of illegal drug use than those with those with average intelligence.

In 1986, the author

discovered what became my drug of choice: the speedball, which is a shot containing a mixture of both (cocaine and heroin) injected simultaneously. Mystifyingly, even though both went in at once the cocaine would always hit before the heroin, blasting its presence with that weird taste and a heart-pounding feeling of triumph and power. Then the heroin would flood in with, calming, soothing and peaceful. I gave myself over to it completely.

She describes dopamine as “the chemical that has become the synonymous with pleasure and the root of all addiction.” This leads to the connection between dopamine and pleasure, desire, and memory and shows how learning shapes addiction so that addiction is, in fact, a learning disorder. Psychology professor Donald Klein parsed pleasures into ‘pleasures of the hunt’ and ‘pleasures of the feast.’ The pleasures of the hunt are the thrill of the chase: excitement, desire, stimulation, intent, a sense of power and confidence in being able to seek and get what you want. In contrast, the pleasures of the feast are those of satisfaction, comfort, relaxation, attainment, and sedation.”

Set and setting are very important to addiction continuing so half the soldiers in Vietnam used heroin, but on returning to America, 80 percent of them didn’t become readdicted. The author describes the frightening parallels between heroin and love, and how a punishment model for addicts hasn’t worked. She also describes the popular twelve-step programs fairly, but points out that 70 percent of referrals drop out in six months. Programs often emphasize the need to hit bottom first before recovery, but Szalavitz asks, “Who is more likely to recover, a guy on skid row or a successful physician?”  

While drug addiction now ravages America with 60,000 deaths each year, the good news is that this is a mental illness that can be overcome. The author correctly points out that with treatment with methadone and Suboxone and education and not punishment, addiction is conquered every single day. This is despite our government’s expensive, misguided efforts. The author herself is a living example of this.

Anyone who is an addict, who works with the nation’s 22 million addicts, or who knows one (and that is every one of us, even though you may not be aware of it), can benefit from reading this accurate, honest, well written and frightening book.