A Revolutionary New Way of Understanding Addiction

This has been a wonderful read--challenging the traditional thought that addiction is a disease takes guts. She's running up against the $$ system that is so entrenched with maintaining this fallacy. (how come smoking is never considered a disease btw?)

I agree with her--addictions are a learning problem and if we spent more time helping teenagers learn how to manage thinking and feelings, we could prevent many of these learning errors and addiction would not end up filling the void. She's done a good job at showing why it is time to look into this.

Interesting

I love the idea that if you want to de-stigmatize addiction you can't do that while making it criminally punishable. There needs to be compassion and respect. Our current system is very far away from that, and she makes a fair point that the criminalization approach has not worked and has cost a ton of money. I agree with her that it is time to try something else and she explains how the "harm reduction" model works.

This book is very well research and very well written. Alternating between her personal experiences and solid contemporary science, Maia Szalavitz systematically and with clinical precision shows how we came to misunderstand addiction and a host of related psychological behaviors in the 19th and 20th centuries and where 21st century science is taking us. But it is more than a science book about “century of the brain;” it is a quite readable book about our continual discovery of how we learn and how our learning shapes our social behavior--in particular additive and compulsive action. This book clearly sets out how what we know about addiction, compulsion, and other mental behaviors is changing--and needs to change--on both a societal and a personal level.

This may not be a comfortable read for those with settled ideas about drug addicts, gamblers and the like. Technology and empirical research is assaulting many myths in this area. And for those who cling to them this book will understandably build resistance. Thus, it is nor suppressing that people who strongly support well-intended and often effective extant organizations such as AA are upset when today’s MRIs and similar advances in neurology produce explanations for addictions that are inconsistent with their old assumptions. And it is hard to accept that racial and ethnic stereotypes, like those of other human traits, unknowingly shaped our views on addicts of all types. But we are now looking at science replacing conjecture and experiment replacing antidote, and Szalavitz makes it clear to any reader why and how this replacement is improving social welfare for all.

Readers of Brené Brown will find this book to be a welcome compliment to her work on socialization, shame, guilt, fitting-in and how to manage those forces in everyday life. Szalavitz work is more academic and science-based in terms of the number of studies looked at and how the studies are conducted and reviewed. But just as Brown describes well the emotional experiences and sensations of dealing with shame and similar social pressures, Szalavitz shows with equal clarity how the same phenomena is operating from inside the brain.

Similarly, those who have read Peter A. Levine’s books on trauma will find the linkages between his work on neurological release of stress well aligned with the emerging understanding of addiction set out in this book. While Levine looks at events creating trauma and how the brain and our nervous system responds (or is not allowed to respond) to those events, this book takes the next step and shows how those neurological responses lead to addictive and compulsive behaviors.

The implications of the science that are captured in this very-readable book are great for broad social policy. But it is also very helpful in creating understanding for those who have to manage addictive and compulsive behaviors, whether in themselves or in their loved ones. It points, for example, toward more successful psychiatry and therapy without the use of drugs. Indeed, regardless of social policy changes, the one-on-one changes in how we treat patients, and the empowering of patients and their families with clearer, science-based understanding of what is needed, may be this book’s greatest impact.

Popularizing the viewpoint that addiction is learned behavior, where people get "stuck" this made a great deal of sense to me. A mixture of memoir and academic research description, with historical background included.

This book is well researched, phenomenally crafted and refreshing in its perspective.

I loved how the author balanced telling a story with making a compelling argument, using nontechnical language with being appropriately nuanced and specific... Not to mention honest in its assessment of our collective blind spots as a country (US).

The author takes the reader on a journey into the drug culture sharing personal experiences, some of which are heart-wrenching. Her history with addiction adds to the well-researched and thoughtful discussion on the subject. Isn't it time for a change in our culture's perspective about drugs and addiction? The author makes persuasive arguments from several fronts, some of which are controversial, like her views on the 12-step program. What surprised me most about the book was how well-written it was. I highly recommend the book for anyone who thinks the war on drugs has failed and could use information on how to change.

The human brain is the organ scientists consider to be the most complex object in the known universe. Overdoses are now the #1 cause of accident death, exceeding even auto fatalities, and at least 23 million currently suffer from some type of substance use disorder. An addicted brain isn't 'broken,' its simply taken a different course of development. Maia contends addiction is the psychiatric disorder with the highest odds of recovery, not the worst prognosis - as many believe.

Author Szalavitz goes from being a 'gifted' child(could read at three, became 'most likely to succeed' in 8th grade, and Ivy League scholarship student to weighing 80 lbs., injecting cocaine and heroin up to 40 times a day, then recovered at age 23. She was out on bail, facing a mandatory 15-to-life sentence on a 1986 cocaine charge - busted with 2.5 kilos, most belonging to her boyfriend's supplier, and living in a $750/month Astoria rental. She'd begun using marijuana and psychedelic in the hope they would relieve her social isolation. Initial experience was that she had no problem stopping marijuana, LSD, and expected cocaine to be similar. After being suspended from college for cocaine use, she thought her life was already ruined and therefore had no reason not to try heroin. Over time, cocaine had made her feel anxious, but heroin always soothed and smoothed. She took both, injecting higher and higher doses.

At least six times she made it through the physical sickness of heroin withdrawal - shaking, diarrhea and vomiting, only to use again. She finally stopped when the addiction threatened her core values - on her last day taking heroin, she found herself considering seducing a man she despised to get drugs - despite having a serious boyfriend. The next day was momentous - Maia was due in court and she also sought treatment that day and never used cocaine or heroin again. Maia underwent 7 days of detox, 30 days of rehab, then three months in a halfway house and ongoing self-help. Later, antidepressant medication helped reduce the distress she'd previously self-medicated with heroin.

She claims that addiction is not a sin, choice, or progressive brain disease like Alzheimer's. Like autism, addiction involves difficulties connecting with others, and like ADHD, is can also be outgrown. (Between one-third and one-half of children diagnosed with ADHD no longer meet the criteria for it as adults, and treatment doesn't seem to affect whether they outgrow the disorder or not.) Addiction is also frequently linked with intense drive and obsessiveness. Early-life trauma can also play an important role in addiction, whereas it plays no role in autism. Maltreated children often appear to have ADHD because they are hypervigilant to sudden distractions like the sound of a door slamming.

Addiction is far less common in people using drugs for the first time after age 25, and it often remits with or without treatment among those in their mid-20s, just as the brain becomes fully adult. Maia contends that 90% of al substance addictions start in adolescence, and most illegal drug addictions end by age 30 - without treatment. (Employment and social support affect recovery in a far greater way than they do with physical illness.) Only 10 - 20% of those who try even heroin, crack, and methamphetamine become addicted. That group tends to have a significant history of childhood trauma and/or preexisting mental illness, and usually finds some way of self-medicating, no matter how much we crack down on substance use. Anxiety disorders, bipolar disorder, depression, and schizophrenia often precede addiction.

Maia's experience with detox was that it wasn't much worse than a bad flu - what makes it wretched mentally are the anxiety, insomnia, and the sense of losing the only thing you have that makes life bearable - providing safety and love.

Maia's book ~ like the works of her other contemporaries (Mark Lewis "Biology of Desire", Carl Hart "High Price") is spot on. All three have the benefit of having first hand knowledge of addiction ~ and years in the field.

Visually Difficult. This may be a good book, but hard to read due to the fine type font. The font is not super small, just very faint - saving on ink?. Readability is poor even in bright lighting, worse in the low light of bedtime reading. I would NOT have purchased if I could've seen the font.

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Having just read the authors NYTimes article, I am ordering this book today. As someone who became addicted in my teens, I have always carried extraordinary guilt about my lost potential caused by going down that path. I was a very gifted child, shy and awkward. I never had the ability to fully socialize,happier with one very close friend at a time, not ever feeling happy in groups. Drug and alcohol use unlocked a whole new world, of socializing and feeling beloved. Inappropriate sexual relationships and years lost "partying"when I should have been focusing on the goals that are important to me, this is something I feel so personally responsible for. I did not fully recover til my 30's, and I will always feel that my addictions, in my case, kept me from having a family, and a fully realized career. Though I am not a religious person, I feel like I sinned, I carry a moral shame for being so very stupid. To understand addiction as a developmental issue and understand myself better, and hopefully move forward without as much guilt, would be a wonderful gift.

Maia Szalavitz tackles the subject of addiction from two very different perspectives in “Unbroken Brain.” The first is from her own experience as a person who struggled with addiction and is in recovery. The second is from the vantage point of addressing addiction as a human-development issue rather than as a choice or a disease.

She proposes that we view addiction as a disorder in an individual’s development and use this perspective to develop effective procedures for treating and managing addictive behavior, and perhaps even preventing it. Further, she posits that addictive behavior springs from wanting to ensure one’s safety, not from deciding to be selfish or rebellious.

Szalavitz maintains that 10 to 20 percent of those who try what she calls the most stigmatized drugs (heroin, crack, and methamphetamine) become addicted, and that most of these people have a history of trauma or mental illness that will lead them to seek out a way to self-medicate, no matter what controls are in place. She also states that addiction “isn’t necessarily a lifelong problem that demands chronic treatment and the acceptance of a stigmatized identity.”

While I commend Szalavitz for the frankness of her personal account, it is a series of vignettes that illustrate one person’s situation. As such, it can suggest paths of inquiry but really it is anecdote and single points of data, not something that can be extrapolated into a larger generality. (I hate saying this because so many of the moments she shares – particularly her reflections on the hell that often is middle school – ring true, but they are anecdote, not data.)

As for the more scientific sections of the book, I am not a scientist and thus in good conscience can only suggest that while reading, you continue to ask yourself whether she is making a plausible case for her characterization of addiction as a developmental disorder.

While the book itself is interesting, the writing is subpar and the way evidence is presented was so biased that it's hard to rely on. The premise is to support the perspective that addiction is a learning disorder. This is interspersed with the author's personal story of addiction, which was by far the more fascinating part of the book.

While I don't necessarily agree or disagree with the author's premise, her ability to use facts impartially to support her points was severely lacking. I would consider the book a statement of the author's opinions, with cherry picked evidence to support her thoughts.

For example, Chapter 16 is mostly a critique of the 12 step program and the author states that positive anecdotal evidence supporting the 12 step program isn't reliable. However, later in the chapter, she happily uses her own anecdotal evidence to support her own opinion based statements about sexual assault. The book is filled with this type of biased presentation of information.

When you try to mix memoir, journalism, and science, unless you are very, very skilled, what you get is something that is confusing, and confused.

There is value in telling people about one's own dark adventures with addiction. But the danger is that, since writing the memoir means that one has presumably come out the other side, what one produces is a triumphalist and self-congratulatory narrative. Another problem, which I think severely undercuts the value of the book as anything but a memoir, is that it's hard to resist the temptation to treat one's own experiences (or report of them) as data. But anecdotes are not data. And when they are reports of one's own experiences, they are even further from consequential.

I won't go on about the science in the book except to say that the things the author gets right have been discussed before. (It's clear, I think, that in light of my view of her unsound angle of inquiry, I think that she gets a lot of the science wrong.)

For readers skeptical about the 'addiction' category, and the insistence that drugs themselves, by themselves, hold lives (or brains) in thrall, I would recommend DeGrandpere's The Cult of Pharmacology. He is a journalist, not a scientist. But both the writing and the science are a lot better.

"Unbroken Brain" is written by a former drug addict, and challenges two widespread ideas. One is that drugs themselves are addictive. In fact, only 10 to 20% of people who try drugs get addicted. The second is that addiction is an issue of willpower or morality.

Instead, Szalavitz argues that addiction is a learning disorder, something like ADHD or autism. When people suffer from any form of trauma (abuse, bullying, lack of proper nurturing and care, abandonment, etc.) and do not have strong coping skills, they are more likely to turn to substances for relief. They do this over and over, until their physical and psychological systems have learned to become reliant.

The problem is intensified during adolescents (when most addicts become addicted), because the human brain goes through a big growth spurt then. We are wired for massive learning. So if we learn that drugs will help our psychic pain, it becomes more hard wired.

At the same time, we can always un-learn behaviors such as addiction, especially if we are allowed to do so in an environment of respect. Humans learn better through enthusiasm and autonomy, rather than mandate, the author says. Thus, we should adopt a multi-faceted approach to healing addiction, balancing new coping skills with real physiological or psychological needs for medication (antidepressants, for instance), while also helping addicts to build a strong social community.

I learned so much from this book. While I felt that a lot of her personal stories could have been trimmed, I admired her candidness as well as her elegant writing.

When I decided to read (listen to on Audible that is) Unbroken Brain I did not think I would like it too much. Some of the public relations material for the book made me think that the book was going to be a superficial critique of drug policies that have already been adjusted over the past decade. I was very much mistaken. Maia Szalavitz has written a serious book that really forces the reader to reflect on both current policies and how we think about drug users. She really seems to be on to something with her core concept that addiction can be thought of as a learning disorder. Further, her first hand account of drug addiction, entanglement in the justice system, various attempts at treatment, and eventual recovery, are riveting. Although I might differ on some of her conclusions on how to re-orient all of drug policy, at home and abroad, many of her ideas on outreach and engagement with drug users seem promising and definitely worthy of further study and assessment. I highly recommend the book, it's a great book and she has a unique and powerful voice.

Let me add that this is a subject I happen to know particularly well. I have worked on Drug Policy for the Congress, as a writer/researcher, and for the Office of National Drug Control Policy for more than 25 years. Over the past few years I have begun teaching a course at Georgetown University's McCourt School of Public Policy on this subject (see [...]) that explores the evolution of drug policy since the Nixon Administration. There is a growing literature of innovative books and articles on this subject from Mark Kleiman, Jonathan Caulkins and other deep thinkers. Maia Szalavitz is now among those who are making a vital contribution to the field.

While this book is another wonderful tome in that it does NOT advocate addiction as a "disease", it is a bit mis-named, as a better title for it would have been, "Anesthetizing The Broken Brain" since the author goes out of her way to explain how her own addiction was actually a response to her own "broken brain", since she does detail having grown up with "high functioning autism". The level of neurological discussion and analysis rivals Dr. Marc Lewis's books on addiction, and this book can easily serve as a textbook in any basic college level course on the "nature of addiction". It is NOT a light read for the most part, and the author's personal story does get lost in the overwhelming detailed discussion of neurology and addiction.
Overall, its not a bad book, but not a casual read either. It is a welcome addition to those seeking a SCIENTIFIC discussion in finding out how and where addiction occurs.

Drugs and addiction have been part of our family for too long, unfortunately. My child has had issues with drugs for years. This book offered a new way of thinking about addiction. The author has written about her own drug problems as well as research she's done. Reading about methadone clinics, being dope sick and living in a mess...is all too familiar. The author believes that addiction is based on a learning disorder. Some of it resonated since I compared what was written to my own child's problems, such as the childhood drama (divorce) and being uncomfortable around others due to social anxiety. I agree that society and politics have distorted how we think about addiction and as the author says, "predominated over science in addressing it." I really believed that some addiction is genetic with addictive personalities, but the other challenges this perception. There are stereotypes for drug users and a lot of that comes from the criminal side of things. I found it enlightening that the author believes that taking drugs is a condition, not just a choice which makes it harder to diagnosis and treat. It is hard to believe it's not a choice, but I understand what she's pointing out. There's so much information in this book that I'm still mulling over quite a bit of it. I highly recommend this book if you're searching for answers about addiction. It opened my eyes to more possible reasons for addiction and I'll be sharing this with family members.

The concept that addiction is some kind of "disease" has never set well with me. I have always considered the indulgence of compulsions and strong cravings as habits and behaviors of coping. This has been my own experience. The content of Unbroken Brain truly resonated with me, and held my fascination from beginning to end. Well-researched, well-documented, with a story well-told, and brimming with anecdotal realism, I like the fact that she used the word "revolutionary" in her subtitle because her perspectives are truly that… And yet they are so very sensible to me, and down to earth. This book offers a fresh, authentic perspective, destined to turn the archaic 12-step model inside out, filling it's holes with truly healing compassion.

Oddly enough, or perhaps not, a family friend recently lost her eldest son, 41, to a death by heroin addiction. You see lots on the news about the rise of death due to addiction, and crime, heartbreak and family difficulties. However, you still don't expect it to hit close to home.

Understanding the science behind addiction, what happens to the thinking process and brain of an addict, and how to help someone out the other side are all discussed here. While there is a lot of scientific research, it's written in a format that is easy for laypersons to understand yet does not talk down to them. Perhaps the best take away information is teaching the children of upcoming generations more about coping mechanisms and problem solving. This will hopefully go a long way towards combating a serious and ever-growing problem.

With all of the information coming at us regarding addictions and the plague that they are- we are often left to wonder how it starts, how it surfaces and how to combat it. Obviously the war of drugs isn't working. The war on addicts isn't the answer. What are we missing?

This book aims to fill in the gaps and presents addiction as a brain development problem. What if it isn't a simple failing, the result of a powerful chemical cocktail that latches on and won't let go? What if it is a result of a missing step or stage or milestone?
Can addiction really be a developmental process or a symptom of something that was missed?

What if it isn't that entirely either? What if it is just the way a certain brain is? This book also explores that too- that addiction is a developmental difference much like autism spectrum disorders or even ADHD and things of that nature.
Sure, this isn't going to please everyone- but if we refuse to look at the problem from all possible angles, we might just miss the best solutions.
I like this book and am glad that I have been presented with a way of looking at a problem that is much different than we are used it. That change is perspective can make all the difference.

The writing style is easy to read, information is packed in there- but not in a way that is boring and preachy. I've read the other two books this author has collaborated on and enjoyed them immensely. This one no less so.

Oddly enough, or perhaps not, a family friend recently lost her eldest son, 41, to a death by heroin addiction. You see lots on the news about the rise of death due to addiction, and crime, heartbreak and family difficulties. However, you still don't expect it to hit close to home.

Understanding the science behind addiction, what happens to the thinking process and brain of an addict, and how to help someone out the other side are all discussed here. While there is a lot of scientific research, it's written in a format that is easy for laypersons to understand yet does not talk down to them. Perhaps the best take away information is teaching the children of upcoming generations more about coping mechanisms and problem solving. This will hopefully go a long way towards combating a serious and ever-growing problem.

With all of the information coming at us regarding addictions and the plague that they are- we are often left to wonder how it starts, how it surfaces and how to combat it. Obviously the war of drugs isn't working. The war on addicts isn't the answer. What are we missing?

This book aims to fill in the gaps and presents addiction as a brain development problem. What if it isn't a simple failing, the result of a powerful chemical cocktail that latches on and won't let go? What if it is a result of a missing step or stage or milestone?
Can addiction really be a developmental process or a symptom of something that was missed?

What if it isn't that entirely either? What if it is just the way a certain brain is? This book also explores that too- that addiction is a developmental difference much like autism spectrum disorders or even ADHD and things of that nature.
Sure, this isn't going to please everyone- but if we refuse to look at the problem from all possible angles, we might just miss the best solutions.
I like this book and am glad that I have been presented with a way of looking at a problem that is much different than we are used it. That change is perspective can make all the difference.

The writing style is easy to read, information is packed in there- but not in a way that is boring and preachy. I've read the other two books this author has collaborated on and enjoyed them immensely. This one no less so.

First of all, Ms. Szalavitz is a very capable writer who weaves anecdotes with more jargon-like content to convey her message with great fluidity and organization. It is very easy for an educated writer to get bogged down in the science which can be so fascinating to her and fatigue the reader in a book of this length, but she avoids that pitfall very well while not dumbing down the content. I appreciated that she wasn't afraid to talk about the specifics of brain structures while also talking about her time as a heroin addict in vivid detail. This is a very "readable" book which avoids being too "scientific" while not being condescending to the more conversant reader.

By her own admission in the book, Ms. Szalavitz admits that the concepts she's talking about are not new, though that does make the subtitle about this being a "revolutionary new way" seem a bit misplaced. I think it would be more accurate to say that she's the first to elevate the status of learning in addiction over other aspects (genetics, biochemistry) and to emphasize treatment with that point in mind. I tend to agree with her conclusions, but there are parts of her presentation which I found off-putting. There is a certain energy and tone which can be seen as "defensive" or "self-serving" in that it seems she's trying to explain away her own experiences and push back against ways in which she felt various systems failed her personally. There is a missing tonal objectivity which makes me feel like someone is trying to suck me into her agenda which I did not find an enjoyable part of the reading experience.

I also felt that there was an over-emphasis on the forces that personally compelled her to take to substances (self-diagnosed ADHD, Autism Spectrum Disorder) rather than a stronger emphasis on the forces which tend to shape a greater number of addicts in the modern world (poverty, abuse). Though she does mention other causes, I feel like they are an afterthought and that made me feel again while reading that this was a more personal presentation than a professional one meant to address the issues in a more balanced fashion. I do believe she has points, but I think that the perspective seems to radiate more from a particular viewpoint which may actually undermine the message.

Despite those aspects of the reading experience, I am very happy to have read this book and even learned a bit about human development that I didn't already know (and I am a lifelong student of psychology who regularly reads journal articles as well as various texts) and had some notions that I was vaguely familiar with reinforced. I think there is an important message in this book for an important component of addiction that is often missed in treatment due to the aspects she discusses in her book. I'd strongly recommend it for anyone with an addiction or who works with or loves an addict.

This is an interesting first person account of the results of addiction and its impact on life by someone who has experienced it, recognized that when you hit bottom you realize you are standing on a trap door, but with the help of others overcame addiction. This book may then be considered a guide to those who are addicted and looking for help as well as a paradigm changer for those involved in treating addicted individuals. How well it communicates to those would certainly be dependent on many factors and there is no attempt as I see it to present this as a cure all of any sort.

Amazingly insightful, Brilliantly delivered, full of hope and inspiration....I could go on and on....suffice it to say that as a sober addict (just over a year now), who tried and tried heroically in the face of acrid judgement (even in meetings!) when I'd fall again and again....could not for the life of me figure out why a Higher Power wouldn't relieve me of my insane obsession to drink and use (yes I did the steps thoroughly)....this book is a "God Send!" Thank you Maia Szalavitz for this generous work of love. This work brings the mental illness of addiction out of the dark ages. Years from now people will look back at this time in history and reflect on how things FINALLY turned a corner when "Unbroken Brain" was published! Amen! And as a post script....please pay zero attention to the negative pseudo-intellectual comments...this book is going to save lives, which is ALL that matters.

The take away from this book is to teach children healthy coping mechanisms before drugs or other substances or activities come into play. The rest of the book is fairly routine, really nothing revolutionary is presented. The author, a recovered heroin addict, adds a human touch, but her perspective, though well articulated, is not objective. At times she seems defensive. Still the theories and mechanics of addiction are presented in a reader friendly fashion. Overall, a worthwhile read.

What a book! With insight, care and intellect Maia dives into the brain and how it drives all that we do. Thank you. To be continued, is my thought on her deep dive into self-care, safety and stabilization every living being seeks and goes to great lengths (some death-defying) to get.