By any measure, the costs associated with addiction and substance abuse in the United States are staggering. According to the National Institute on Drug Abuse, the total costs of drug abuse and addiction due to the use of tobacco, alcohol and illegal drugs are estimated at $524 billion a year. Illicit drug use alone accounts for $181 million in health care, productivity loss, crime, incarceration and drug enforcement.
But you don’t need a governmental report weighed down in abstractions to understand the scope of the problem. Talk to your co-workers, neighbors, and friends or just about anyone else you come in daily contact with and you are bound to find – sooner rather than later –someone who knows someone else with some form of substance abuse or addiction problem.
And that someone else might just be as likely to be a member of the LGBT community as anyone else. More so actually. According to the Center for American Progress, it is estimated that between 20 to 30 percent of the LGBT community has a substance abuse problem compared with just 9 percent of the general population.
Of course, it’s nothing terribly groundbreaking to learn that a community that is routinely bullied, dehumanized, physically and verbally abused and otherwise treated as social outliers would seek a means of drowning their pain in drugs and alcohol. But the question – one of many – is why some of us seek refuge in the blinding haze of drugs to obscure life’s uglier truths and others don’t.
But if you were expecting an article that would help to sort out the voluminous body of scientific research on addiction, you will be disappointed. Our goal here was to explore – and in turn help you explore – other avenues to understanding addiction that, while still curiously sidelined, are being pushed up through the cement like blades of grass determined to take their place along with other important facets of addiction and recovery.
So, in that spirit, we turned to Maia Szalavitz. Maia Szalavitz is a neuroscience journalist obsessed with addiction, love, evidence-based living, empathy and pretty much everything related to brain and behavior. She is the co-author of Born for Love: Why Empathy is Essential – and Endangered (Morrow, 2010) and The Boy Who Was Raised as a Dog (Basic, 2006), both with Dr. Bruce D. Perry. Her 2006 book, Help at Any Cost: How the Troubled-Teen Industry Cons Parents and Hurts Kids (Riverhead, 2006) is the first book-length exposé of the “tough love” business. Szalavitz has been published in Time Magazine, the New York Times, Elle, Scientific American Mind, the Washington Post, New Scientist and Psychology Today, among many others. She has been awarded the American Psychological Associations Division 50 Award for Contributions to the Addictions and the Media Award from the American College of Neuropsychopharmacology.
San Diego LGBT Weekly: Thank you so much, Maia, for taking the time to talk to us. First off, can you define alcohol/substance addiction over and above recreational/social use?
Maia Szalavitz: Sure. The main distinction is that in substance abuse disorders you get compulsive use that interferes with functioning and it goes on despite negative consequences. So it doesn’t have anything to do with whether you suffer withdrawal, how much you use even. You could be extremely OCD and extremely successful and if the symptoms aren’t really interfering with your life, you really don’t get the clinical diagnosis.
What is the “disease” theory of addiction?
AA defines alcoholism and addiction as a disease and a chronic-long relapsing brain disorder, basically. But scientific authorities have picked up the chronic brain disorder [theory]. Where it gets weird is that the 12 step program has ‘amateurs’ treating what the scientific community normally treats. And the best treatment, according to AA, is meeting, confession and prayer. And that’s not a very medical way of dealing with it. That’s not to say that a lot of people aren’t helped by 12-step programs, but many people often need something very different.
Do you believe it is a disease?
I see it actually as a developmental disorder and what I mean by that is it’s similar to, say, autism or dyslexia. But it’s really almost very rarely developed after age 25. So the real risk periods are adolescence and young adulthood and a lot of people age out of it after that time. But I prefer to see it as a development disorder in part because there is a lot of learning in it. When you’re a teenager you haven’t really developed other ways of coping and if you get involved in drugs as a way of coping then you’re not going to learn those other things. If you’ve made it to age 25, you’ve generally learned some ways of coping without drugs. And so the risk of addiction gets a lot lower at that point.
I don’t believe it’s a sin and I don’t’ believe that it’s your fault if you’re the person who gets addicted versus the other person who does not. There are choices involved and there are impairments of will but it is not as if you’re a bad person.
Why is it that minority communities like the LGBT community seem to face such a disproportionately big problem with alcohol and substance addiction?
There are many different parts to that. The primary part is oppression and oppression is incredibly stressful. Being and feeling different and being bullied all contribute to a stress physiology that makes you really seek some kind of escape. Not to mention bullying. And then there is that bars are generally a good place to meet people, and there is alcohol there, and if you are some kind of minority, there may fewer options other than bars to meet up at. But I still think that really it is the stress of being an outsider, being constantly demeaned and attacked.
How does an individual come to realize that they have an addiction problem and what can they do to start addressing the problem?
I think one of the important things to recognize about addiction is that there are a million ways into it and a million ways out of it, so what makes you become an addict may be very different than what makes me become an addict.
I think there’s this whole notion that addicts are in denial and people don’t realize they have a problem and all of it. I think people pretty much do know when they have a problem. It’s that they’re very scared of what getting help will mean. Because often times unfortunately – and this is changing a bit – a lot of treatment is demeaning and humiliating and attacking and exactly the opposite of what you’d like to experience when you’re sick.
So people would rather just continue struggling along with the addiction than not only know they have to give up the drugs but also that it’s going to be painful, difficult and made worse by people treating you crappily.
Sometimes the first to notice are family and friends. How should they deal with the situation?
With great compassion and gentleness. Because we know that the confrontational interaction, where you all get together and yell and say that the person is ruining their lives and ruining everyone else’s lives and how could you do this to me, increases the amount of shame that people experience. Sometimes people even commit suicide. That’s what happened to Kurt Cobain.
You want to go at this the way we would treat someone with cancer or depression. People are scared of getting help. So what you need to do is say that the point of this whole thing is to be happier and more comfortable. It’s not the punishment. So what you want to say is, OK we’re going to get you help and if the help sucks we’re going to take you out and get you better help. And if you can align yourself with the person and not be seen as trying to control or trying to fix them, the easier it is to get them to get help. The more you can relieve the shame, the better people will feel and the better people feel the less likely they need to escape.
So it becomes a positive cycle rather than a vicious one and this can be very hard because active addicts can do things that destroy trust and be awful to live with and relapse does happen. The main thing is that you know you want to treat yourself and the other person with compassion.
Is the 12-step total abstinence program the only real way of dealing with the problem?
Absolutely not. And I think our system made a real mistake when it made 90 percent of available treatment based on the 12-step.
I think the 12-step can be a wonderful, wonderful form of help for a lot of people. They helped me personally. They’re available 24/7, they’re free, they’re peer-based, they’re empowering in some senses and not in others. But they can be very useful.
But my feeling is that they should have no role in formal treatment. So I think professional treatment – and more and more of this is happening – should include cognitive behavioral therapy, motivational interviewing, mindfulness-based therapy and relapse prevention that is based on those things because there is some intervention stuff that isn’t very scientifically based.
So there are definitely a lot of different options and sometimes they can be hard to find. But there are many; there are just as many ways to get recovered as there are to get addicted. Actually a majority of people recover on their own without 12-step.
Now if somebody is in real trouble I would recommend that they get help rather than just waiting it out. The reality is a lot of people find their resource within themselves or within their community.
The real problem with addiction is that you’re in pain and you do not often have a sense of meaning and purpose in your life. And this is why there are so many religious fixes for it because for some people religion can offer a sense of meaning and purpose.
But there are many other ways you can get that: through a job, through a relationship, through children, through volunteer work, through art, through community. All of these things can be very fulfilling for people and often important to recovery.
How does treatment for the different addictions work. Are they more or less the same?
For me personally, and I went to treatment in the bad old days, I didn’t have, thankfully, a particularly horrible experience. I was so messed up. I had these wild mood swings. I was really euphoric sometimes and those moments gave me the hope that it was going to get better. Actually one of the most powerful things for me during early recovery was a guy in an AA meeting said something along the lines of he was just talking about how he’s now married, he has a good job, he feels good. This guy was talking about the positive. I think you know the way to get true is to try to realize that this problem isn’t your fault.
Everybody makes bad choices. People with addictions make bad choices. People with addictive tendencies who make bad choices with drugs develop addictions and there it is.
The thing that was worse for me was hating me for hating myself. It was that extra sort of meta level of hate that made my consciousness unbearable.
So if you can just ease up and say, hey, you’re human. It’s OK it will get better. If it doesn’t, get help. I will get help that will make it get better.
Really, I think every single person with addiction needs to have a psychiatric evaluation very early on and in an ongoing way because (for me) the real underlying stuff was depression and when I get on anti-depressants about five years into my recovery it made a massive difference. And I think for a lot of people that can be lifesaving. Don’t’ rule anything out. We have to use what’s out there and you shouldn’t turn up your nose at any resource. If one thing doesn’t work you can try something else. You just have to avoid hopelessness.
The main thing is to know you’re not alone. You will get better and keep telling yourself this will get better. I had a really hard time believing people cared about me when I was in treatment. I thought everybody hated me. And I was awful. It was a real revelation to realize that I was thinking that but that wasn’t necessarily the objective truth.
One of the good things about support groups is that you will see some famous model sitting there going on about how ugly she is. And you’re, like, what? Maybe I’m similarly self-deluded. Not that I’m secretly a model, more just that I am sort of not recognizing my strengths. I think it’s really important to get support from other people and remember it will get better.
What about relapse; is it inevitable? Have you relapsed? How does someone in recovery come back from a relapse?
I did not relapse actually. I did not have that problem. But something like 90 percent of people will relapse at least once. It’s very, very common.
You should really look at it like a learning opportunity. OK, what led up to this? I like to think of it like a diet. Nobody is going to be perfect. Everybody is going to have a cookie sometimes.
Don’t think, OK, I screwed up. Now I might as well binge because I’ve lost all my time. You don’t have to do that. You can just get right back on the wagon, as it were. Dust yourself off and go on and try to learn from what happened. You just need to learn what led up to that and try and prevent that from happening again.
If you’re just beating yourself up and making yourself feel bad because of it, it’s going to lead to another relapse. So it’s better to say: OK, I screwed up, this sucks but now I can get on with it.
