Unbroken Brain: interview with journalist and author Maia Szalavitz

POLITICAL PERSPECTIVES

UNBROKEN BRAIN: AN INTERVIEW WITH JOURNALIST AND AUTHOR MAIA SZALAVITZ

MAY 18, 2016

TRANSCRIPT

DOUG MCVAY: You're listening to Political Perspectives on KBOO radio in Portland, 90.7FM on the dial, KBOO.fm on the web. I'm Doug McVay.

Drugs and drug addiction are a complicated set of issues. Unfortunately, our political responses tend to be overly simplistic, tinged with all sorts of prejudice, with a policy debate often characterized by emotional appeals, hysteria, and bluster. What's needed is a better understanding of drugs and drug addiction. We need help with the whole story, especially who, what, and why, and it needs to be communicated in such a way that people actually get it.

I'm a data guy, so let's look at a couple of the numbers. According to the Center for Behavioral Health Statistics and Quality, which is part of the Substance Abuse and Mental Health Services Administration of the federal Department of Health and Human Services, in 2014, an estimated 27 million Americans aged 12 or older were current, that is past month, illicit drug users, meaning that they had used an illicit drug during the month prior to the survey interview.

The most commonly used illicit drug in the past month was marijuana, which was used by 22.2 million people aged 12 or older. An estimated 6.5 million people reported non-medical use of psychotherapeutic drugs in the past month, including 4.3 million non-medical users of prescription pain relievers.

According to that same report, approximately 21.5 million people aged 12 or older in 2014 had substance use disorders in the past year, including 17 million people with an alcohol use disorder, and 7.1 million people with an illicit drug use disorder. An estimated 2.6 million aged 12 or older had both an alcohol use disorder and an illicit drug use disorder in the past year.

Those numbers really need to be taken with a big grain of salt. That's an estimate based on questions inserted into the National Survey on Drug Use and Health, to screen people for the possibility of a substance use disorder. They're not diagnoses. According to, again, the SAMHSA report, the National Survey on Drug use and Health, the questions related to dependence ask about health and emotional problems associated with substance use, unsuccessful attempts to cut down on use, tolerance, withdrawal, reducing other activities to use substances, spending a lot of time engaging in activities related to substance use, or using the substance in greater quantities or for a longer time than intended. The questions on abuse ask about problems at work, home, and school; problems with family or friends; physical danger; and trouble with the law due to substance use.

And now for some really chilling numbers. In 2013, the last year for which we have really good data, a total of 46,471 persons died of drug induced causes in the United States, according to the Centers for Disease Control. Thirty seven percent of those deaths involved opioid analgesics. It should also be mentioned that many of these opioid deaths were in combination with benzodiazepines or with alcohol.

Thing is, these are big numbers. We really need help understanding them. And more to the point, we really need help in understanding drugs and drug addiction. We need help with the whole story, especially who, what, and why. And it needs to be communicated in such a way that people will actually get it.

That brings us to our guest today, the writer and journalist Maia Szalavitz.

Maia is one of the top reporters covering addiction and drugs in the world. She writes frequently for Time Magazine, the New York Times, VICE, Elle, Scientific American, and others. Her book Help At Any Cost was the first book-length expose of the abusive “tough love” business that dominates addiction treatment, particularly for teens. She is co-author of several other books. She's a 2015-2016 Soros Justice Fellow, and has received major awards for her coverage of neuroscience and addiction from the American Psychological Association, the Drug Policy Alliance, and the American College of Neuropsychopharmacology.

Maia's new book is called Unbroken Brain: A Revolutionary New Way of Understanding Addiction. In it, she uses her own personal experience of overcoming heroin and cocaine addiction to offer groundbreaking new ways of addressing drugs and addiction.

Unbroken Brain challenges both the idea of the addict's “broken brain,” and the simple notion of an addictive personality. Maia offers a radical perspective, arguing that addictions are essentially learning disorders. She shows how seeing the condition from a developmental perspective can untangle our current debates over treatment, prevention, and drug policy.

I have the good fortune to have Maia on the phone now. Maia, how are you?

MAIA SZALAVITZ: I am good, thank you so much for having me.

DOUG MCVAY: Ah, thank you for doing this. And first, just congratulations, it's a terrific book.

MAIA SZALAVITZ: Thank you.

DOUG MCVAY: I just got my copy of Unbroken Brain this weekend, and frankly I've only been able to skim through it because my partner – who has a degree in counseling psychology with a focus on addiction, though she does not work in the treatment field, largely due to some deeply-held philosophical disagreements and concerns about that industry – anyway, she hasn't put it down since it arrived. I had to wait until she went to bed just to get a look, she's been so absorbed. She identifies very strongly with you and your story --

MAIA SZALAVITZ: Oh, cool.

DOUG MCVAY: and the science -- yeah, I just -- it's one of the best books she's come across in many years, and --

MAIA SZALAVITZ: Well, thank you.

DOUG MCVAY: For the benefit of the listeners, and kind of for me, how about let's start at the beginning: could you tell folks a little about yourself, and how you got started as a journalist writing about drugs and addiction?

MAIA SZALAVITZ: Sure. Well, in my 20s, I unfortunately became addicted to cocaine and heroin. I got into coke, oddly enough the first day I did cocaine was with Jerry Garcia, which is a story I tell in the book. And I was involved with the Grateful Dead scene, as that would suggest. And I, you know, I had discovered that drugs, and even just talking about drugs, was a way to make social connections, and I'd always just had a really, really hard time making social connections. And, I was always this sort of obsessive person who just got really, really into things, and then went on and on and on about them. And so people were not especially interested when I was going on about, like, science fiction or opera, but when it was drugs, it kind of gave me social currency.

And so I got into psychedelics, I got into the Grateful Dead, and then, you know, got into coke that way. I should say that was the 80s, when, you know, something like 50 percent of American adults said that they had used cocaine, so it was incredibly prevalent and it has never been that prevalent since. This was right before crack.

So, anyway, so that is how I got into the whole drug thing. And how I got into journalism was, basically, that I'd always kind of wanted to either be a journalist or a scientist, and I was too squeamish to slice up rats. So, I decided that I -- and neuroscience is my interest, so there was kind of a lot of rat slicing that was going to be involved. So, I basically decided that writing about science would be the best sort of way down the middle, and because of my personal experience with addiction, I realized that this was an area that really could benefit from science writing in particular, because so much of what we know about drugs and addiction, or think we know, is actually wrong.

DOUG MCVAY: Indeed, and you, in your book, go through and puncture many of the myths that are so prevalent about drugs, and drug dependence. Now, for instance, for years, people thought of drug use and dependence as a moral failing. These days, we're told -- by the drug czar's office, by the National Institute on Drug Abuse, and others -- that it's a brain disease. Those are both wrong, but, could you explain to the listeners how are those ideas wrong?

MAIA SZALAVITZ: Sure, sure. I mean, actually, so, basically, we have said for the last, you know, hundred years of drug prohibition, that, you know, addiction is a disease, but the treatment is either locking you up or putting you into a 12-step program, which requires confession, finding a higher power, praying, and all kinds of moral things.

So it's really hard to convince people that they have a brain disease but, unlike Alzheimer's, which unfortunately for which we have no treatment for, but unlike any brain condition that we do have a treatment for, we're going to make you list your sins. This does not sound like any other disease, and it does not make a very convincing argument, so I'm not surprised that the public, you know, sort of doesn't buy it, when the politicians and the experts and the doctors, you know, make this disease claim.

And I'm not saying that addiction is not a medical problem. I'm saying that the kind of medical problem that it is, is a learning disorder, and what I mean by that is that addiction requires learning in order to occur. Like many developmental disorders, it seems a mix of both environmental and genetic stuff's going on. And so with addiction, if you don't learn that a drug solves your problems, you can't be addicted to it because you wouldn't know what to crave. That sounds kind of dumb and obvious, but it is the case that, without that learning piece, the whole thing falls apart.

The way addiction is defined medically is as compulsive drug use despite negative consequences. So what this basically means is that if you learn that drugs fix you, and then you continue to use them despite negative consequences, you meet the criteria. What's interesting about that to me is that, you know, for the last hundred years we've tried to use punishment to treat addiction, and yet, addiction is actually defined by resistance to punishment, which is just another word for negative consequences. So basically, if negative consequences worked, addiction couldn't exist.

DOUG MCVAY: Why do you think we have such a hard time shaking that idea of addiction as a moral failing?

MAIA SZALAVITZ: I mean, I think there's a few pieces to it. I think one very unfortunate and very tragic piece is that our drug laws come from racism. And if you look at the historical origins of the drug laws, they are so racist as to be almost humorous in a very, very sick way. So you have, you know, cocaine being made illegal because supposedly it made black men resistant to bullets. You get opium being made illegal because it would make Chinese men seduce white women. You have all these things that are basically results of racist and ethnic fears, that are projected onto the substances, and that really have nothing to do with the substances, but all of that gets mixed into our concept of addiction, for one.

And then the other thing is that, when you see people with addiction, they look like they're doing what they want to do. They look like they're deliberately planning to get high, deliberately lying about it, deliberately hiding what they do in order to preserve it, and so that doesn't look like a disease to people.

What people are missing when they see that, though, is that if you become addicted, it's basically like falling in love with a drug. So, when you fall in love with somebody, or when you have a kid, your priorities become completely rearranged, and because that's in a positive way when you fall in love, usually, and a positive way when you have a kid, almost always, universally pretty much -- I don't think it's ever bad to love your child -- so, you know, if you have those, you know, sort of priority changing experiences in your brain, it does rewire your brain such that your stress is only relieved when you are feeling okeh about those connections. And if that connection is with a drug, then you will behave very strangely.

The thing that, you know, people don't get is that, this idea that all people with addiction are like liars or cheats, or that kind of thing, you know, you could say the same thing about all people who are having affairs. It's the same kind of behavior. Does it mean that people with addiction have absolutely no self control? Obviously not, because nobody's shooting up in front of the police. But, you know, does it mean that there's an impairment in control that cannot be seen necessarily? Yes. And so, you know, your brain isn't hijacked, but your priorities have been shifted.

DOUG MCVAY: It sounds like it could be -- it sounds like, practically, loneliness would be a, is a big reason for drug use. Is that fair?

MAIA SZALAVITZ: Absolutely. I mean, for drug use that becomes problematic, yes. I think there's plenty of people, you know, 80-90 percent of people who take drugs and do not end up having addiction. But, the people who are having addiction tend to have a few things in common. For one, they tend to have some kind of developmental difference that may be a predisposition to other mental illnesses, maybe sort of some experience of sensory overload. About fifty percent of people with addiction have another mental illness, and, you know, the genes that set that up are, you know, pre-existing, and they may require some kind of environmental stimuli to come out, but, you know, they are something that is not chosen.

Then the environment, you know, something like two thirds of people with addiction have at least one really traumatic childhood experience, and the more child trauma you have, the higher risk you are for addiction. So, you know, those two things are crucial in setting up addiction risk, and then the other thing is this sort of general despair. If you have no sense of meaning and purpose, if you feel like there's no hope in your life, if you feel like there's no reason to bear the, you know, sort of awful stuff that happens in the world all the time, then you may well be drawn to things that can blot out your consciousness.

DOUG MCVAY: You are listening to Political Perspectives on KBOO radio in Portland. I'm your host Doug McVay. My guest is Maia Szalavitz, author of the new book Unbroken Brain: A Revolutionary New Way of Understanding Addiction.

Maia, we're told -- currently, repeatedly in the news, that there's an opioid epidemic in this country. Is that an accurate statement at all?

MAIA SZALAVITZ: Well, there's certainly an overdose epidemic. I mean, we've never had this level of overdoses. And, you know, there certainly is a higher level of opioid misuse than there has been in the past. I think that what -- it's not necessarily problematic to phrase it as an epidemic. What's problematic is to think that the cause is simply the fact that pharma advertises these drugs.

I mean, I'm not saying that Purdue Pharma, which made Oxycontin, is innocent, by any means. But what I am saying is that two thirds of people who -- or more than two thirds of people who misuse prescription opiates are misusing somebody else's prescription. So most of the misuse that's going on is not in pain patients, and is in -- it involves drugs that have been diverted from the medical system.

So, this idea that doctors are turning people into addicted people is simply, generally, not the case. While it is possible to get addicted during pain treatment, since most pain patients are over, you know, 30 or 40, and most addiction starts in the 20s or teens, if you don't have a previous addiction, and you are prescribed opioids, your odds of becoming addicted are generally very low.

So why are we seeing this big overdose problem? I think that what's going on is that the middle class is collapsing. Particularly, the white middle class is under stress in ways that it has not been in the past, and this has caused a sense of despair. And it has led to a lot of opioid misuse, particularly among young people, who are just, you know, so-called recreational users.

And then what you're also seeing is middle aged people with previous addictions getting exposed to these drugs, and you're also seeing people who are just using these drugs to commit suicide, and it's not being labeled as suicide because, you know, that is better for insurance purposes, it's less stigmatizing, etc. So we really don't know what proportion of these overdose deaths are actually suicide, and I think that's something that we really need to find out.

DOUG MCVAY: Indeed. I know that there are quite a few folks in the veteran's community that -- among our veterans, who are doing a lot of advocacy around the number 22, which is the reported -- the estimated number of suicides per day among US veterans. It's scary. And, but, yeah, the notion then that there might actually be more -- [low whistle]

MAIA SZALAVITZ: I know, I mean, it is truly awful, the way things are, and I think, you know, we as a society have unfortunately, you know, we have this idea that you're supposed to be independent, and that, you know, your success is entirely due to whether you work hard or not. And when it becomes impossible to succeed because the economy is basically rigged against the average guy, you end up with people becoming suicidal because they blame themselves.

And when people come back from, you know, having fought for their country, and getting no support whatsoever, you end up with that same kind of thing. We really have, like, a fraying social fabric here, and, you know, one of the best defenses against addiction is love and social support. And obviously that's not to say that you can't become addicted if you have that, but it's almost impossible to recover without it.

DOUG MCVAY: Before we talk more about addiction generally, let's talk for a second about, well, about pain. And some of the -- back in the 90s, we started taking pain seriously as an actual, treatable condition. Opiates began being more widely prescribed, medical marijuana started to become available as a treatment option. In the last ten or so years, there have been steady attacks on pain docs, and patients, and policies have been shifting again. How far has the pendulum swung, in terms of how we view and treat pain as a condition? And the way we treat the patients who suffer?

MAIA SZALAVITZ: Yes. I mean, this is an absolutely horrible situation, and not enough media attention has been devoted to it. The vast majority of people with chronic pain who use opioids do not misuse them. Now, there are certainly cases where people are taking opioids chronically, and they're not benefiting from them especially. But that doesn't mean they're addicted. And there are also people who are taking opioids chronically who benefit tremendously from them, and are not addicted. And those people I hear from virtually every day online, telling me about how they got, you know, screened out at the pharmacist or their doctor cut them off, or, you know, there was an article today about how patients with sickle cell anemia are just being made to wait hours and hours in the emergency room.

And, you know, doctors are terrified to prescribe, there's all this pressure from the CDC guidelines, which means that, you know, if your prescribing is at all different from everybody else's, you're going to get looked at, and somebody's got to be the top one percent prescribers. So, it's just causing people to say, you know what? I could go to jail, I could lose my license. this is too much of a hassle, I'm going to just assume that anybody who wants opioids is an evil drug seeker, and this is easier for me to deal with, and, you know, if somebody could have benefited but can't now, well too bad, I can't risk, you know, my whole life for that.

So yeah, so this has gotten really, really terrible for pain patients. I think we may be beginning to see, you know, some more attention paid to the plight of pain patients. You know, there's been this whole push, oh well if they just do yoga or get acupuncture, or whatever. I have not talked to a single chronic pain patient who hasn't tried ten thousand things before they discovered that opioids was the thing that worked for them. And so, if I were a chronic pain patient, I would find it frankly offensive to be told some of this stuff.

But, you know, it is a complicated thing. Opiates probably work about a third of the time, which is as good as anything -- which is better than anything else we have. You know, I mean, any, even, anti-depressant only works probably about a third of the time, and yet for many of us, those drugs can be lifesavers.

So, you know, this is a complicated problem. But what we're doing now, by simply shifting people from legal sources to illegal sources, and not providing support, not providing effective treatment, you know, it's just dumb, and tragic.

DOUG MCVAY: Indeed. Again, you're listening to Political Perspectives on KBOO radio in Portland. I'm your host Doug McVay. My guest is Maia Szalavitz, author of the new book Unbroken Brain.

Now Maia, what I really love about your book is that you bring light to the truth about substance use and dependence, you puncture the many myths that many people, sadly including a number of legislators, simply accept as a given. I'd like to, if I could, go through a few of those myths with you now.

MAIA SZALAVITZ: Sure. Sure, totally.

DOUG MCVAY: Cool. I'll set them up and you knock them down. The first one, the basic one, the idea of “once an addict, always an addict.”

MAIA SZALAVITZ: Well, the data certainly does not support that. If you look at the research, you can see, these are from large samples of tens of thousands of people, that people who qualified for a diagnosis of what was formerly called substance dependence and is now called substance use disorder, the vast majority of them stopped or cut back without any professional assistance. So, the idea that, A, if you ever had a drug problem you can never use any drug safely again is simply not true, and the idea that, you know, if, that nobody who's ever had a problem can ever moderate is also not true.

DOUG MCVAY: Okeh. Now, well, let's, we talked about this a moment ago, that, the idea that addiction is a chronic, progressive brain disease.

MAIA SZALAVITZ: Right. So, the data here, again, is quite instructive because most addictions start in the teens and 20s, and by age 30, fifty percent of all addictions, with the exception of tobacco, are generally over, as I said earlier, either resolved by abstinence or by moderation. So, if addiction were a progressive disease, you should see older people getting less and less likely to recover, so the longer you've been addicted, the less likely you should be to recover. The exact opposite is true. As people get older, they are much more likely to recover.

DOUG MCVAY: Let's look at the solutions. Now, one is the, we hear about this quite a lot these days, you know, this new era of drug policy reform, it's the idea that coercion and incarceration are the best way to get people into treatment.

MAIA SZALAVITZ: Well, I mean, that is absolutely not the case. The thing about addiction is that it is basically falling in love with a drug, and that means that you have prioritized that over pretty much your other relationships. And so, if addiction is defined as compulsive behavior despite negative consequences, coercion using negative consequences isn't going to be the best way to help, in fact, it's going to be the worst way to help. So what people with addiction need is not shame, humiliation, and force. They need love, compassion, and hope.

DOUG MCVAY: So, how is it that drug courts have had any success?

MAIA SZALAVITZ: Well, there are several things that are going on there. For one, they cherry pick these people to participate, and basically, if you create really strict requirements for letting people in, you can get 80 percent success rates quite easily, although the drug courts do not accomplish that. But, you know, I love these studies where they have only doctors, and they go, oh, we got an 80 percent success rate! Well, yeah, if I put everybody with addiction through medical school and got them a job I'd get an 80 percent success rate too.

So, you know, but the other thing about drug courts is that, in terms -- you have to look at them in context. So, if you compare a drug court where, you know, you have the option to get help versus getting a fifteen year prison term, that's a pretty good idea, that is much more compassionate. The problem is that if you compare it to the way we deal with alcohol, and that, like, we attract people into treatment rather than necessarily forcing them, you can see that that is not such a good thing.

So, you know, drug courts, my feeling is that they -- if somebody has committed a crime that is harming other people, and they have an addiction, I don't think it is wrong for society to want to punish them in some way. We just need to separate that from treatment, because treatment should be medical, not punitive. Just the way we have in mental health courts, if somebody commits a crime that's related to their mental illness, we're not punishing them for having a mental illness, we're punishing them for the crime, and we're trying to treat the mental illness as a medical problem, which it is, so that it does not get repeated.

DOUG MCVAY: Let's shift to an actual solution, and that's of course substitution treatment. Another of the myths that you bust in your book is the idea that substitution treatment, like methadone or buprenorphine, is simply trading one addiction for another. I know that's wrong, but for the benefit of the listeners, could talk us through that one?

MAIA SZALAVITZ: Sure. And, this is why I actually do tend to avoid the use of the term "dependence." Basically, what happens is, with addiction, it's compulsive behavior despite negative consequences. So you're shooting up, you're getting sick, you are possibly committing crimes, you are losing your family, you're having all this bad stuff happen. Now, you go to substitution treatment, and you get a pure, steady dose. And what happens with opioids, when you do a steady dose, is that you get complete tolerance to the high. So, people who are on, taking the same dose at the same time every day, are not high, are not impaired, can drive, can take care of their kids, can do anything else anybody else can, because they are completely tolerant to the drug.

And what the maintenance gives them is the ability to avoid withdrawal and possibly some of these people may have had a deficiency in their natural opioid systems before they became addicted, or developed one during the course of their addiction. Either way, it becomes very similar to taking an anti-depressant every day or taking insulin every day. It is just depending on a substance to function. That is not addiction. Addiction has negative consequences, so if the consequences are positive, and the person's health is not at risk, which is the case when you have a steady safe dose, there can be some side effects as with any drug but, you know, the benefit of substitution treatment is enormous because methadone and buprenorphine used long-term are the only drugs that we have that are known to cut the death rate from opioid addiction by fifty percent or more, and, so, abstinence treatment doesn't do that.

And given that, you know, two to four percent, something like this, die each year from opioid addiction, you can see that you get very quickly up to a very high death rate if you are not doing something to reduce it.

DOUG MCVAY: You just mentioned the body's own natural opiates, the endorphins, yes?

MAIA SZALAVITZ: Yes.

DOUG MCVAY: And it's -- I'm just -- well, I've made the argument before regarding the cannabinoids, that maybe a person's endocannabinoid system isn't working properly and that's why for some people, cannabis use is, you know, helps them function in a normal way. It hadn't even struck me that, well, of course, you know, the same could be true of the body's own opiates, the endorphin system. We accept the idea that our neurochemicals may not be, you know, we may not have a, you know, that we may need a boost or we may need something to suppress one thing or another, but the idea that these basic things, we just presume they always work perfectly. But they just, they don't necessarily, do they? Hmm.

MAIA SZALAVITZ: No, well, I mean, this is what's very silly and what causes a tremendous amount of harm to people, is that we assume that everybody's starting out from the same baseline. And that is simply not the case. If you have been, you know, beaten every day, raped twenty times, you know, have no education, have no job, have no chance of ever having a good job, and you are considered sort of coming from the same baseline as somebody who, you know, went to an Ivy League school, and, you know, has parents that are supportive and that, you know, doesn't have all this trauma, it's kind of absurd. We just think that people randomly bang into a drug and they get, you know, they walk down the street, a needle shoots them up, then suddenly they become addicted. Like, that is not how it happens.

People who become addicted are people who are generally unhappy for some reason. You know, I've heard a lot from people who, you know, say to me, oh, you know, I did, like, crack, or I did heroin, and it was the best thing ever, and so I knew immediately that I could never do it again because it would ruin my life. Those are the people who don't get addicted and don't write their story up because it would be a really boring story. The people who do get addicted, on the other hand, you know, they have stuff going on. And so, you know, we really need to understand that people do come from different baselines, whether it's for genetic, environmental, or some complex developmental mix of both of those things.

You know, there may be some person who is born, like, you know, extremely hypersensitive to, like, stimuli, which was the case for me. So, like, moderate things that would be boring experiences for other people were kind of overwhelming for me. So, we don't know about that from looking at them from the outside. And, if you try to give a drug that makes somebody less sensitive, to somebody who is undersensitive, they're going to feel numb and horrible and think it's the worst thing ever. But if you're oversensitive, and you're going from, you know, being too much down to normal, then that drug may be the best thing for you ever.

It's the same drug, it's having different effects on different people, and that's what we sort of can't seem to understand, I think.

DOUG MCVAY: You know, a big difficulty with expanding access to substitution treatment has been getting beyond the NIMBY objections. Plenty of people support the idea of treatment as long as the clinic's in a different neighborhood and out of sight. That attitude is just wrong on so many levels, among other things it makes it tougher for the people in those neighborhoods who need those services to actually use them. How can we get people to think these things through and get beyond some of those objections?

MAIA SZALAVITZ: I think, two things. I think every emergency room should be allowed to and prepared to give people a maintenance dose of drugs if they walk in the door, and give them their name so that they can't get more than one. So, that way, you would cut down on the hostility between doctors and patients in the ER, where they think that people are just faking in order to get drugs to avoid withdrawal. If you can say, look, you don't have to fake it, here are some drugs to avoid withdrawal. That would be a really good thing.

That would be a very low threshold maintenance program, right? You could show up every day, just get a dose, and no counseling, you just do your thing. And that would reduce the risk of overdose by 50 percent right there without anything. Now obviously, if you want to stabilize your life and get your life together, you want a more comprehensive opioid program.

Again, if we put these in hospitals, the hospital's already there. People with addiction are already in the ER, the people with addiction are already in the hospital. So, if we put it there, you can't have the NIMBY thing going on because the hospital's already there and people don't want their hospital going away. So I think that is one way of doing it. And I think the other thing that's important, which is already happening, is that parents of people with addictions are speaking out and saying, you know, hey, it was, like, my straight A student who became addicted, and it was my, you know, incredibly talented athlete that became addicted. In other words, it's us who becomes addicted, not them.

Because once you see it as us, you start to get very different solutions, which is why again the racism in this is so disgusting, but now that you see that, you know, white people are being perceived as the people with a problem, suddenly it's treatment not punishment.

DOUG MCVAY: Okeh, Maia, while we still have time, I need to ask a rather self-serving question. Not long ago you were in Baltimore to address a group of journalists about covering drugs and drug addiction. I was working at a different conference, I couldn't make it to your talk, so for my benefit as well as the listeners, what advice did you give to those reporters?

MAIA SZALAVITZ: Well, the first thing I would say is question everything. Unfortunately, for a really long time, the media has not been skeptical enough of our drug policy, and it has basically repeated these sensational and often racist myths about addiction without checking. You know, a policeman says, like, oh, you know, this guy was on PCP and he had the power of ten men. Well, okeh, is that really true? If you actually look at the rat research, at least, on PCP, it makes muscles weaker. You know, there's an entire medical literature on this stuff that nobody ever looks at.

So, the first thing I would say is, you know, be extremely skeptical. And secondly, cover this like a science journalist, not like a crime journalist or a political journalist -- no offense. But, you know, really, really look into the science so that you are focused on what we actually know, what we don't know, and can go from there rather than just being, well, Joe said this and Jane said that, and we're not going to take any perspective.

DOUG MCVAY: Right on. And no offense taken, I try to cover science and politics, so.

MAIA SZALAVITZ: Okeh.

DOUG MCVAY: Kind of straddle all things. Gosh, now, it has improved, hasn't it? I mean, I remember the 80s, and that was --

MAIA SZALAVITZ: Yes.

DOUG MCVAY: ridiculous.

MAIA SZALAVITZ: No, it has improved tremendously, and I mean, I think a sort of major under-covered story is how the internet forced it to change. Because once you have all these internet fact checkers, and the actual experts can respond to your completely bogus claims, the media has to start getting better at what it does, because otherwise people are just going to go straight to the experts and are not going to pay attention to the media.

And obviously, we've had tremendous upheaval in how journalists get paid, etc., but the, you know, the fact that if you make a bizarre, wrong, scientific claim, and then the researcher can instantly say on his blog, that gets widely tweeted and, you know, widely disseminated, that this is completely bogus and here's the data that shows it, you're going to start being more careful.

Also, the early days of the internet were sort of dominated by people who were either liberals or libertarians, who were very pro-legalization and pro-drug reform, and they sort of were among the founders of the 'net, and that sort of created a bias that, in a good way, shifted against the overwhelming consensus that everybody thought that prohibition is a good idea and would be a good idea forever. So, it, like, that early advantage of this, at first very marginal view, helped the internet sort of become a place where, you know, you could actually get access to honest, factual information. And when people saw that, they began to stop believing the nonsense.

DOUG MCVAY: So, in a way, we could say that some of the recent successes in the last few years -- legalization initiatives, broader acceptance of harm reduction -- may just come down to better communication and better access to information.

MAIA SZALAVITZ: I think that's true. I mean, obviously, I do not want to discount the hard work of many, many, many activists, that obviously counts a lot. But the 'net allows them to organize in a way that they hadn't previously been, and allowed views from the, you know, outside, to get into the mainstream in a way that hasn't been as well chronicled. But, actually, a friend of mine, Alissa Quart, wrote a book about how the outside is now moving inside, and how this has sort of changed everything, and I think the internet and drugs is a really good example of that.

DOUG MCVAY: Oh indeed. Well, yes, I mean, the internet, the web, it's a tool, and a tool is only useful if it's put to use. And that we have done, that we have done.

MAIA SZALAVITZ: Yes. I mean, I think, like, one of the things that is amazing is, like, the Erowid site [erowid.org], and that site, you know, is just bunch of people, well, more than this, but it includes thousands of peoples' experiences with drugs, and there you can see the experiences that do not lead to addiction.

DOUG MCVAY: You are listening to Political Perspectives on KBOO radio in Portland. I'm your host Doug McVay. My guest is Maia Szalavitz, author of the new book Unbroken Brain: A Revolutionary New Way of Understanding Addiction. Maia, what kind of impact do you hope that your new book, Unbroken Brain -- this is your sixth book?

MAIA SZALAVITZ: I think it's seventh.

DOUG MCVAY: Seventh.

MAIA SZALAVITZ: Yes. But one of them was kind of ghost-written, so there would be no way for other people to need to know that. So, but, yes, what I would hope is, and the point of writing the book, really, was, I wanted to get us past this, it's a crime, it's a disease, debate. You know, I don't mind if you call it a medical disorder, or even a disease as long as you understand that that does not mean that your brain is broken or that it's progressive. But, you know, there's no evidence that people with addiction are just horrible, obnoxious people who are hedonists and want to destroy their lives and the lives of their families for the sake of ten minutes of being high. That is not what's going on in addiction.

People with addiction have more pain and trouble before they become addicted, and that is why they tend to become addicted. So, I just wanted to have a way to get past that debate, and say that it's medical but not say that it's medical in the way that we have done, that has unfortunately supported criminalization and has supported keeping addiction treatment out of mainstream medicine.

DOUG MCVAY: I've got to ask. I just came back from New York, the United Nations General Assembly Special Session on drugs was, at the time of this recording, just a week ago. The world's nations got together and basically did very little.

MAIA SZALAVITZ: No.

DOUG MCVAY: And yet, you could argue that we've made progress because they did not endorse the global drug war and declare that we'd have a drug free world in ten more years. How do you think that the debate is shifting, and where do you think it's -- in a year from now, with your, a year from now your book is still going to be on the New York Times bestseller list, and how do you think the debate is going to be changed?

MAIA SZALAVITZ: Well, I really hope so. I think that the UN meeting was fascinating in that yes, it turned out that nothing happened, but also, simply the fact that the United States is in violation of the UN conventions because our states are -- some states have legalized and more states will probably do so soon, means that we can't act as the world's narc anymore, and we can't go stomping around into Canada and say, No you can't legalize, you're violating the conventions, and we're going to mess with you regarding trade if you do that. And we did that kind of stuff in the past, all the time.

So simply having us out of commission as the world's drug cop is a good thing. And, you know, the fact that, yes, we didn't say we're going to have a world free of drugs in ten years, I think they said we're going to have a world free of drug abuse in ten years but -- which is almost as silly -- but, it is progress. And I think there is probably a threat to sort of international law if we don't come up with a way to either say, oh well, yes, these conventions, no matter what they said in the past, actually do allow states to legalize if they feel like it, or actually change them. Because otherwise they will become irrelevant, because we're going to have lots of countries doing lots of different things, and I mean it may not be a bad thing if they become irrelevant, in terms of the drug laws, but it might be a bad thing in terms of the UN's credibility on other issues, and that is something that, you know, people really need to think about.

DOUG MCVAY: What kind of drug policy should we be aiming for?

MAIA SZALAVITZ: I think we should -- well, we should legalize marijuana, there is no reason not to legalize marijuana. We should decriminalize possession of all drugs, because locking people in a cage does nothing to fight addiction, and stigmatizing drug use does not prevent people from becoming addicted, in fact it may make them more likely to become addicted. So, you know, criminalizing drug possession, low level drug possession, and low level drug dealing, has made, has done no good, has done tons of harm.

But, how do we deal with something like cocaine and heroin, where, you know, you really don't want Phillip Morris crack. You know, I wouldn't be especially happy with Phillip Morris marijuana, but it could not, because of the nature of the substance, do anything like the kind of damage that Phillip Morris crack could do. So, how do we deal with these other substances? I think that's going to require a longer term discussion, and figure out, you know, and being able to figure out the best ways to use regulations, and the best ways to, you know, figure -- because I can't figure out a way to stop the violence of the trade without some form of regulation of the product.

The alternative could be things like legalizing less harmful versions of things. You know, but there's all kinds of -- simply making progress toward decriminalization for users would be an enormous improvement. And as we legalize marijuana, there are going to be different models of it, so we should see, what is the role of commercialization? Like, if we allow a completely insane commercial market, like, how bad does it get? I obviously don't want that to be a problem, but, you know, it's possible that it could be. I mean, I think personally that even if you marketed marijuana excessively, you would have so much positive substitution for alcohol and perhaps opioids to some extent, that it wouldn't be a problem. But you know that's an empirical question, and while I would absolutely prefer non-commercial sales, I think we are going in the direction of commercial sales because it's the way the United States is set up, and I think since regulatory capture is definitely a thing that can happen, we really want to, before we create a market for something, restrict the marketing and restrict these kinds of things, so that we can minimize harm.

I think that, you know, people have been using drugs since before we evolved into humans. If you just look at cats and catnip, you know that mammals like to get high. So we're never going to have a drug free world, or a world of -- world free of consciousness alteration, nor would we want to. You know, what we want to do is minimize related harms, just like we wouldn't want to have an exploration free world, or a risk free world, you know, that would be insanely boring. So, you know, we need to come up with ways to minimize harm and reduce risks, but it's never going to -- nothing is ever going to be perfectly safe.

DOUG MCVAY: For the benefit of listeners who aren't up on drug policy, you mentioned minimizing harm, harm reduction. Could you talk about that for just a minute or two, because this is -- I mean, it's an important thing, and as a stopgap, it's, well, vital.

MAIA SZALAVITZ: Yes. I mean, I think that, you know, basically the idea of harm reduction is that drug use is going to occur, and drug addiction is probably going to occur, so how do we make sure people don't die, how do we make sure people don't spread diseases, how do we make sure that, if people do become addicted, they have access to care that can help them recover? You know, it's kind of like, if you just think about seatbelts in cars. We didn't ban cars because they kill lots and lots of people. We recognized that, you know, people like driving, and there are useful things that can be had in terms of that. So we do things to reduce harm.

So, it's not like this is like some kind of novel concept. With drugs, the sort of classic harm reduction intervention is needle exchange to prevent the spread of HIV. And one of the really interesting things is, when we started doing needle exchange, people were afraid, oh my gosh you're going to encourage people to use more, you know, they'll never get into recovery if they have access to clean needles, and you're going to, like, enable them. All of that turned out to be false. In fact, when you treat people as if they deserve to live, whether or not they do what you approve of, you make them feel a lot better, and when you make people with addiction feel better, they are less likely to want to escape and get high.

And this is, like, this thing that we really don't understand, is that being tough and being cruel, and attacking people with addiction, that is why they get high. So if you want to actually have them not get high, you want to find ways to have them have hope, and have them, you know, feel okeh in their own skin. So, harm reduction is a really valuable way of doing that, because when you give somebody a clean needle, or an overdose-reversing shot, or a safe injection facility where they can go and use and in case anything bad happens there are medical professionals there to help, when you do that, you say I believe your life is worth living. And when people start to believe that they are valued by others, they start to value themselves, and when you value yourself, you're not going to want to destroy it.

DOUG MCVAY: A lot of great things that people have to think about, and it all goes back to what you were saying, it's about, you know, connecting, and love, and compassion. Things that a society should do.

What question have I forgotten to ask you? What question should I have asked you that I haven't yet?

MAIA SZALAVITZ: I think you have been pretty thorough there. You know, I think that it's a complex subject, and it's a highly emotional subject, and people have been taught a lot of things that are actually harmful. So the more we can just actually look at the scientific research, actually try to listen to each other and empathize with each other, and understand that, you know, we can be coming from different places but that doesn't mean that the person who is really different and experiencing things really different is like bad or wrong.

You know, I mean, this stuff sounds kind of really basic. But, if you, you know, it really does come down to empathy and compassion, and it is kind of amazing to see what happens when you just treat people with dignity and respect, and how enormously helpful that by itself can be. Is that all you need? No, unfortunately not. But once you recognize that, you know, people who use drugs and people who are addicted to drugs aren't these crazy aliens who are going to do all kinds of bad behavior, you can then begin to understand what's going on and, you know, have people live healthier lives.

DOUG MCVAY: Maia, any closing thoughts for the listeners? We're coming up towards the end of the hour, the clock has beaten us once again. I don't know how it keeps doing that, I think the clock cheats. So, any closing thoughts for the listeners? And oh heavens yes, let's, you have a website, I think, and I follow you on Twitter, but what's your Twitter handle?

MAIA SZALAVITZ: Oh sure. It's, so the website and the Twitter handle are the same. They are M-A-I-A S like Sam, Z like Zebra, so it's @maiasz for Twitter, and maiasz.com is the website. And I also have a column that is in Vice, and another column that is on an addiction related website called The Influence. And I'm just, I really am excited to hear from people who have really been finding the ideas, seeing addiction as a learning disorder. I found that a lot of people have found this really helpful, so I look forward to hearing from you.

DOUG MCVAY: Right. Well, once again I've been speaking with Maia Szalavitz. She's the author of Unbroken Brain: A Revolutionary New Way of Understanding Addiction. It's on sale now everywhere. You can find more information about the book, and about Maia and her work, at her website, and that's M-A-I-A-S-Z DOT COM, maiasz.com. Maia, thank you so very much for your time, and the best of luck with the book.

MAIA SZALAVITZ: Thank you as well, this was lovely.

DOUG MCVAY: You have been listening to Political Perspectives on KBOO radio in Portland. Our guest was Maia Szalavitz, the author and journalist whose new book is Unbroken Brain: A Revolutionary New Way Of Understanding Addiction. I've been your host Doug McVay. Thank you for joining us.