Is a Lack of Bonding the Cause of Addiction?

for addiction.com

The drug war has failed. This fact, central to journalist Johann Hari’s book, Chasing the Scream: The First and Last Days of the War on Drugs, is virtually irrefutable. Study after study has shown that incarcerating addicts does not rehabilitate them, and criminalizing drugs does not make these substances disappear. On this topic, Hari makes, as many others have done, a solid case about the harmfulness of the War on Drugs.

The other part of Hari’s testimony, however, is more problematic. In exploring the hugely complex question of who becomes addicted to drugs and why, Hari asserts that addiction results from a disconnection or the lack of “bonding” an individual has to his or her environment. According to this theory, environment includes not just your family but your community and any social groups or institutions to which you belong. In the book, he interviews a scientist who describes high rates of addiction among people who have experienced trauma in childhood, and another researcher who discovered that rats tend to ignore cocaine when they are in a healthy, stimulating environment. Hari argues that this is why some people can use drugs and alcohol and not become addicted while others cannot. Simply put, those people who have a connection to their environment don’t become addicts. Those who don’t have that connection likely fall into the 10% of the population addicted to drugs or alcohol. (It’s worth noting that Hari focuses primarily on addiction to substances, not behavioral/process addictions to food, gambling, sex, video gaming and the like.)

Addiction’s Complex Picture

This idea of bonding (or a lack of it) as the root cause of addiction is definitely an intriguing notion, and one that — at least judging by book sales— excites a lot of people. On the surface, it makes a lot of sense: If people are happy and well-bonded to the people, organizations and institutions in their environment, they will have no desire use drugs or alcohol addictively. If this is true, then recovery from addiction will definitely not happen through criminalization of drugs and jailing those who become addicted to them, but instead through “reconnecting [addicts] – both to their own feelings, and to the wider society,” as Hari writes.

Hari is not examining the whole picture of addiction, however, and he’s getting some important details completely wrong. The major flaw in the bonding argument of addiction is the notion that drugs/chemicals have little to do with addiction. This ignores the decades of scientific evidence linking drugs to physical changes in the brain. As Derek Simon, PhD, a neuroscientist studying the neurobiological basis of drug addiction at the Rockefeller University writes in a blog post, “[Hari’s argument] makes no mention of the vast amount of concrete basic research that has identified real molecular changes that occur in the brain as a result of drug use and the subsequent effects on behavior that these molecular changes have.” Dr. Simon continues, specifying that, “there is no mention of neurons, or dopamine, or neurotransmitters … or many other of basic concepts in the neuroscience of addiction” in Hari’s book.

Indeed, there is almost no mention of neurotransmitters anywhere in Chasing the Scream. Neurotransmitters are the chemicals that our brains naturally produce to carry signals between neurons. These signals cause different reactions depending on the pathways they take. For example, as David Sheff notes in his book Clean, “cocaine, methamphetamines, and other amphetamines (forms of speed) cause a spray of the chemical [dopamine, one of the ‘feel good’ neurotransmitters] as if from a fire hose.” The way drugs interact with our brains, triggering cells to release certain neurotransmitters is what makes them pleasurable and, consequently, addictive. This process can also affect the brain in a way that can fundamentally alter the release mechanism of neurotransmitters. The result is a craving for increasing quantities of the drug.

So why do some people become addicted to drugs and others don’t? Environment is likely a factor for many addicts. But it’s not the whole story. For example, a 2012 study of cocaine addicts published in the journal Science and cited in Sheff’s book showed that “neurological abnormalities in addicts appear to predate drug use.” Essentially, it found that some people have brains that make them predisposed to addictive behaviors. This is largely a dysfunction of the brain’s reward/braking system. Imagine two kids biking down a dangerously steep hill. The first one reaches the bottom of the hill, high on endorphins but also relieved to have made it down without getting injured. That amount of adrenaline and excitement is enough for Kid #1. When Kid #2 makes it down the hill, he’s also pumped with adrenaline, but unlike Kid #1, Kid #2 wants to keep going. He wants to find a steeper, more dangerous hill and ride down even faster. His reward system is flushed with endorphins but he’s not satiated. There’s no braking system; he wants more.

Endorphins are the only neurotransmitters that Hari discusses in Chasing the Scream. The chemicals are mentioned once, in a discussion with Ronald K. Siegel, associate professor in the department of psychiatry and biobehavioral sciences at the University of California, Los Angeles. Siegel explains that endorphins are naturally occurring morphine-like compounds released in the brain during times of stress and fear. There’s nothing unnatural about intoxication, in other words; it’s part of natural human experience and shouldn’t be criminalized. Hari writes: “[The ability feel high] is in our brains. It’s part of who we are.” It’s curious, though, that the example of endorphins is used to support the assertion that drugs should not be criminalized, but elsewhere the book fails to include a full discussion of neurotransmitters and their role in the brain and in addiction, as shown by any number of studies.

Hari also neglects to mention a hugely significant piece of the puzzle of who does and doesn’t become an addict: genes. Science has long been aware that, in many cases, addiction has a heritable component. This oversight might be forgivable if the book’s stated focus was on the ways in which the War on Drugs has failed and Hari argued for the need for a more holistic, compassionate treatment of drug addicts. When he asserts that addiction is determined primarily by external experiences, though, his argument makes it necessary to disprove the decades of science that map the biological component of addiction.

Like Hari, I believe the War on Drugs has failed. As a recovering alcoholic, I know that a large part of my recovery is a result of precisely what he describes as “reconnection”: the rebuilding of my life and connection to the people I love. Hari is not alone in his support of the bonding/ connecting theory of addiction, and there are also numerous studies supporting it as well; I appreciate his efforts to humanize addicts and found Chasing the Scream to be a compelling read on the failure of the War on Drugs. When it comes to the causes of addiction, however, Hari’s theory is both overly simplistic and incomplete.

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3 thoughts on “Is a Lack of Bonding the Cause of Addiction?

  1. Reblogged this on Dr. Simon Says Science and commented:
    A well-written criticism of Johann Hari’s popular yet woefully inaccurate book “Chasing the Scream”. The piece is written by fellow addiction blogger Katie Mac Bride for addiction.com. Thanks to Katie for quoting me in the piece!

    Like

  2. Looking for constructive criticism of Hari’s book brought me to your blog. In Hari’s defence, I haven’t seen him claim that his book details the minutiae of addiction from neuronal action to environmental conditions. It seems he wanted to bring together an overview of the war on drugs, its consequences, and interesting research which raises the idea that our current understanding of addiction is at best underdeveloped, at worst verging on erroneous.

    Whilst Derek Simon might be correct that addiction causes molecular changes in the brain, so does watching TV, reading books, even meditation. Neuroplasticity is a well-studied phenomenon that shows how the brain changes in response to environment and behaviour. It’s not surprising that addiction, which can radically alter ones behaviour, also causes structural change over time. This in no way invalidates Hari’s claims of childhood trauma at least having a possible effect on later addictive behaviour.

    I’d also be cautious of the linked cocaine study detailing brain abnormalities in a small set of 50 siblings, which uses very ambiguous language to suggest that an abnormality might play a part in addiction. I’ve searched online journals for further details, but could find no clarification on what the abnormality in the fronto-striatal systems actually is, nor how frequently the abnormality is ‘typically’ seen in others who struggle with drug addiction and those who don’t (keeping in mind 50% of the siblings with the ‘abnormality’ have no addiction to cocaine.) It’s an interesting study, but not one that can be used in any conclusive fashion.

    The same can again be argued in regards to the article which details a genetic footprint that has been discovered in alcoholics. Looking at the study itself, it is based on lifetime alcohol consumption, and does not even mention alcoholism. The linked article actually misinterprets the original study (http://www.nature.com/mp/journal/vaop/ncurrent/abs/mp2014159a.html) to fit its own agenda. Also, only a mild correlation was found, which does not imply causation.

    The linked articles in support of your dismissal of the research presented in Hari’s book are flawed and in one case wilfully misrepresentative of the research it was based upon.

    I’m replying in the hope that people will actually research these ideas, rather than reading articles which appeal to authority, but in fact misrepresent the research they are using to argue their side.

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