Why substances don't cause addiction

Why Substances Don’t Cause Addiction

If you are old enough to remember the Reagan years, you remember Nancy Reagan’s campaign in the 1980’s: “Just say no” to drugs and alcohol. It was based on the philosophy that if you can stay away from substances you would not get “hooked,” and I commend her effort. The problem was that according to science, the “just say no” strategy simply never worked. It also gave momentum to the war on drugs that we have today. Let’s take a look at the science of why this didn’t work, and what does work.



We see evidence that drugs and alcohol don’t cause addiction by looking at several large studies. The National Survey on Drug Use and Health showed that 90% of people who drink or use drugs regularly never become addicted. That in itself should be a shocker to anyone who is sold on the idea that substances automatically create addiction. Another huge study showed that when painkillers are prescribed appropriately, they don’t cause addiction. And if you’re an inquisitive person, you might be wondering: “But what about heavier use?” We’ve got that covered too. Only 7% of people who drink 5 or more drinks a day have an addiction. I apologize if this isn’t the case for you or someone you’ve watched fall apart with alcohol. But you have to realize that 93% of the world can drink a lot and not suffer from addiction.



If drugs and alcohol are really the cause of addiction, then we would expect to see addiction go away if we remove the substance. But that is simply not what we see. If it were, we’d set up more detox centers and people would walk out cured. We wouldn’t need therapy or rehabs or anything beyond a way to remove the substance for long enough. We could set up a little drug-free island (scratch that… enormous island) for people to rotate through and return without issues. Frustrating to all of us, that doesn’t happen.



Don’t get confused with an important note we must make. Addictive things do cause real changes in the brain (and central nervous system), and so the body always pushed back. If you take a downer (like alcohol or a benzodiazepine) your body will naturally pump a bunch of its own stimulating chemicals (like adrenaline). If you do that for long enough, you will always get a physical dependence to the substance. But that is very different than the full picture of addiction. If all you have is a physical dependence, then you are the type of person who can just decide to go through withdrawal for a little while and kick the habit. These are the types of cases where detox does indeed work really well if you need that extra kick in the ass to stop. As a psychiatrist, it’s a nice break to have an easy case. But the reason it’s easy is because that’s not addiction. Don’t let these cases fool you (as they fool many) into believing that anyone with addiction could do that too if they only tried harder. Different people, different problem.



In perhaps the most famous case we have to learn about this, we luckily collected data on American soldiers during and after combat in Vietnam. About 20% of soldiers were addicted to something (most often a potent form of heroin). But after they returned home from war, about 95% of them no longer had an addiction. This shows us that the act of using an addictive substance is not what causes ongoing addiction. It will predictably cause a physical response, so those soldiers would have certainly gone through withdrawal. But if heroin on its own could cause true addiction we would have seen the opposite outcome.



I have no doubt you’ve read about one of the hundreds of rat studies that show how substances cause addiction. Here’s what they usually don’t tell you. Those poor rats who were forced into “addiction” to a substance were cured as soon as they were given other options or more space. This was proven with a series of studies at rat park. What this tells us that addiction is about life suffering or lack of options (otherwise known as hopelessness). When are we going to start studying what conditions help the rats. How helpful would it be to compare different changes like socializing, space, options, lack of threats, etc.? I have no doubt that yet another report will show us just how addictive the latest new drug is based on the latest rat study.



If addictive chemicals automatically cause addiction, we would see addiction rates many times higher (mathematically higher, that is) than we see. Nobody would disagree that substances cause a physical dependence. But what we are discussing here is addiction. The type of addiction that you came here to learn more about. If you’re going to argue that substances by themselves cause addiction, you’ve got a lot of explaining to do.



If you ascribe to the notion that substances cause addiction, you join a large group of people who believes that someone who drinks or uses drugs will be cured by removing the substance. That means things like locking people up, and teaching people to “just say no” just as Nancy Reagan did. But incarceration (a whole other sickening topic I will talk about in another blog) and the Reagan approach are proven ineffective. If, on the other hand, you can trust that substances are not the cause of addiction, it lets us all look more honestly at what does actually help. Addiction is the story of human suffering. Turn suffering on and you create addiction (as seen with Native Americans only after being horribly persecuted and near extinguished). Turn suffering off and it vanishes (as seen with the soldiers who returned from Vietnam). That’s why what is proven effective are things like love, support, opportunity, skills building, treatment, acceptance, mentorship, and a slew of other very humane approaches. That might take more trust than many are willing to give, but I promise it’s the way.

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