For decades, scientists believed that addictions were driven by the pleasurable effects of the substance/behavior in question - that addicts compulsively seek the enjoyable "addictive effects" that make life fun, fun, and more fun. It was thought that addicted individuals become unduly tied to this pleasure train, seeking the feeling of "being high" even when their lives are falling apart as a result. And this belief was not unreasonable, given the fact that addictive substances and behaviors trigger a huge surge of dopamine (and other hyper-stimulating neurochemicals) in the brain, resulting in feelings of excitement, power, control, contentment, etc. It seems only natural that after experiencing this type of pleasure we'd want to go back for more, again and again.
On the surface, this dopamine-centered analysis rather neatly explains the all-too-human propensity for addiction. Even the National Institute on Drug Abuse once gave this theory a stamp of approval. However, if this pleasure = addiction theory is correct, then everybody who ever enjoyed a glass of wine would eventually become alcoholic, anyone who ever took an opiate (even by prescription) would eventually become a junkie, etc. But that's not what happens. In fact, only around 10% of the people who experiment with an addictive substance or behavior get addicted.
So there must be more to addiction than just pleasure. Certainly pleasure opens the doorway to addiction, but it doesn't exactly push people through and then lock the door behind them. So what does drive certain people toward addictive substances and behaviors over and over, even when their lives are disintegrating as a result?
Modern science tells us that the risk factors for addiction are part nature and part nurture - a witch's brew of genetics and environmental factors. Research also tells us that one of the biggest risk factors is social/emotional disconnection. The initial breakthrough in this regard came in 1980, when Canadian scientist Bruce Alexander started to question the results of studies where rats were placed in cages with two water bottles - one with pure water, the other with opiate-infused water. These pre-Alexander experiments uniformly found that rats almost always opt for (and eventually overdose on) the opiate water. In other words, these studies found that rats would rather have "pleasure water" than regular water, even if it kills them. Addiction in a nutshell, right?
Not for Alexander. He recognized that rats are social creatures - much like humans, which is one of the reasons they're so useful in psychological experiments - and that the opiate water studies involved isolated rats in tiny cages with no toys or other possibilities for stimulation. Alexander thought, "Of course they get high. What else are they supposed to do?" In response, he created The Rat Park, a great big cage with cedar shavings, empty cans and boxes to play in, and a high ceiling so the rats could climb around and frolic. Most importantly, he put not one rat but twenty into the cage. And then he repeated the opiate water experiments. Unsurprisingly (to Alexander), his test subjects had less of the drugged water. It seems they were much more interested in typical rat socialization - playing, fighting, eating, mating, and the like - than in getting high. Even rats who'd previously been isolated and drinking the spiked water chose regular water after they were placed in The Rat Park.
In the 35 years since Alexander's study, we have come to realize that addiction is not all about the brain's pleasure response as scientists once thought. Instead, the equation is much more complex, and it nearly always involves healthy socialization (or, more accurately, a lack of healthy socialization). Essentially, we know now that a significant percentage of addicts had dysfunctional childhoods that taught them to "not fully trust" caregivers and other loved ones. They were neglected, abandoned, abused, or otherwise traumatized as children, and the lesson they learned - don't trust people - has caused them, as adults, to feel ill-at-ease in the human rat park.
And that is the crux of addiction for a large percentage of addicts. Basically, these individuals are not looking to feel good, they're looking to feel less. They don't drink, get high, gamble, act out sexually, or whatever because they want to experience pleasure, they do it because they want to escape their feelings. And the neurochemical intensity wrought by addictive substances and behaviors helps them do this.
The good news is that addicts who were not blessed with secure, healthy attachment in childhood (and who therefore struggle with healthy connection in adulthood) can learn to securely attach. Most often this occurs through therapy, support groups, and other healing relationships. Please notice that each of these pathways out of emotional discomfort (and therefore out of addiction) involves healthy intimacy with other people. In other words, the long-term antidote for addiction is not willful sobriety, it's connection.
Consider, for example, the nation of Portugal, where illicit drugs were decriminalized in 2001. Since then, instead of spending money on arrests, judicial proceedings, and incarceration, Portugal has focused its resources on treatment programs, social support, and reintegration into society. Unsurprisingly to me, problematic drug use in Portugal is down since 2001, as are drug related deaths, incarceration rates, etc. So it looks as if Portugal's strategy of treating and connecting rather than isolating and incarcerating has been effective.
The question I pose here is how the US can effectively incorporate a similar strategy to deal with our own addiction epidemic. Needless to say, such a drastic change in policy won't come easy, politically or socially, but scientific evidence tells us that we should try for it nonetheless. If you have ideas on this, I would love to hear them.
Robert Weiss LCSW, CSAT-S is senior vice president of clinical development with Elements Behavioral Health. He is the author of numerous books, including Sex Addiction 101. For more information, please visit his website.
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