What Causes Addiction?
“What if everything you think you know about addiction is wrong?” This is a question posed by New York Times best-selling author Johann Hari in his 2015 book Chasing the Scream. The book has become an international phenomenon in recent times. It continues to generate publicity. (If you haven’t heard of it, you can take a look inside the book on Amazon.)
With a tagline that reads, “The First and Last Days of the War on Drugs,” Hari demonstrates an unwavering commitment to historical accuracy. His illustration of how illegal drugs have stormed (and seized) America is unparalleled in modern literature. Indeed, the book is a noble attempt to answer an age-old question, “What causes addiction?”
Hari Says That Environment Causes Addiction
There is no doubt that Hari’s acclaimed nonfiction work is a brilliant literary piece. However, we believe his answer to this question is too simplistic – and, thus, incomplete. Essentially, Hari asserts that environment is the sole cause of addiction.
The conclusions he draws from much of the research he presents could be considered pseudoscience. They make no allowance for the fact that some substances are addictive and that genetics play a part.
In this article, we will discuss a few points Hari makes in his attempts to explain what causes addiction. We will also offer a few of our own. Substance abuse is a major problem in America and around the world. If researchers understood its root cause, they might be closer to finding a solution.
Chasing the Scream – An Overview
To write Chasing the Scream, Johann Hari went on a three-year journey that spanned over 30,000 miles and several continents. He wanted answers to questions many of us have pondered ourselves. For instance, what causes addiction? Why does the United States continue to wage the War on Drugs? And, how can we really help addicted people find freedom?
After all his research, Hari said in a TED Talk, “The thing I realized that really blew my mind is almost everything we think we know about addiction is wrong.”
Hari bases this assertion on several key points he makes in his TED Talk. We will discuss the following three:
- People go to the hospital all the time to undergo surgery or get treatment for injury. While under medical care, they are repeatedly injected with diamorphine (also known as diacetylmorphine) . (This opioid is often used in the UK. In the U.S., morphine is much more commonly prescribed). If opioids are as addictive as we have been told, everyone who left the hospital would become what he calls a “junkie.”
- A 1970’s science experiment on lab rats was conducted by Bruce Alexander called “Rat Park.” It proved that addiction is caused solely by environment and social disconnection.
- The Vietnam War proves Alexander’s Rat Park study. Ninety-five percent of all heroin-addicted soldiers stopped using when they returned from combat.
Quite frankly, Hari is only telling half-truths – which aren’t truths at all! More specifically, the author is perpetuating myths. Let’s talk more about these points. We will explain why the “science” doesn’t jive when it comes to explaining what causes addiction.
Before you continue reading, take a moment to watch Hari’s Ted Talk:
Hari’s Myth # 1: Substances Aren’t As Addictive As We Have Been Told
Hari has said that certain drugs (like heroin) aren’t as addictive as we have been led to believe they are. He says this is the so-called “Demon Drug Myth.” He bases this assumption on the idea that when people take opioids in a hospital, they don’t become addicted. He says they just walk right out of the hospital and return to daily living. He says that if drugs are so addictive, people should leave the hospital and become “junkies.”
Hari talks about the typical “little old grandma” who goes in for a hip replacement. She takes painkillers for several weeks, but she doesn’t leave the hospital and go try to score heroin. Instead, she stops taking the medication and suffers no consequences.
It may be true that many people take opioids at the hospital and return to their lives without a serious habit. However, Hari does not acknowledge that almost everyone who suddenly stops taking opioids experiences withdrawal. This is proof positive that these drugs are, in fact, addictive substances. They have a pharmacological inclination to produce physical dependence.
FACT: People DO Become Hooked On Opioids During Hospital Stays
Furthermore, the truth is, people DO leave the hospital hooked on painkillers. The problem has become so widespread that surgeons have started prescribing less opioids after surgery. The idea is that the longer someone takes drugs like Hydrocodone, Oxycodone, and Fentanyl, the greater their risk is for physical dependency. The less they take, the less likely they are to become hooked.
You only have to read stories about people like Las Vegas paramedic Heather Leavy to understand that opioid use at a hospital can lead to addiction. Leavy received high doses of narcotic painkillers in the hospital after a C-section. She was also given a prescription for Percocet to take home. It wasn’t long until she started to abuse her medication.
“Before I went to work I took them, and to get the kids after school I had to take them,” she said in an NPR article. “Then I was taking them just to go to bed. I didn’t really realize I had a problem until the problem was something more than I could have taken care of myself.”
Leavy said she became like the addicted people that she often transported by ambulance. She even lied to emergency room doctors to score a few pills. Leavy ended up losing her job, her fiancé left her, and she had to go to rehab to get help. All because she was given opioids in the hospital.
So much for people not getting addicted while receiving medical care. Hari’s point that drugs aren’t as addictive as we have been told they are has been debunked. NEXT!
Hari’s Myth # 2: Rat Park Proves That Addiction is Caused Solely By Environment
In the 1970’s, there was an experiment conducted to test how rats would react to addictive substances like Morphine. A rat was placed alone in a cage and given access to two bottles – one with water and the other with a drug cocktail. Almost every single rat would self-administer the drugs until they died. At the time, this test gained significant notoriety for proving how addictive drugs could be.
A few years later, another scientist named Professor Bruce Alexander conducted a similar study. However, he put rats together in a large cage and created “Rat Park.” The cage had things for them to play with and it allowed them to interact with other rats. It contained the same two bottles. The rats in Rat Park rarely touched the bottle laced with drugs and they never overdosed.
The social disconnection and environment in the first study caused addiction in rats. When a community and change of environment was offered to a different group of rats, they did not become addicted. Therefore, environment and social disconnection cause compulsive drug use. Alexander ultimately applied this research to human beings. (Hari applied Alexander’s research to drive home the idea that environment causes addiction).
Alexander said this in Chasing the Scream: “Human beings only become addicted when they cannot find anything better to live for and when they desperately need to fill the emptiness that threatens to destroy them.”
He also concludes, “Addiction isn’t you. It’s the cage you live in.” This is the basic premise of Chasing the Scream.
Here’s a video that explains the Rat Park experiment:
FACT: The Rat Park Study is Imperfect
According an article in Outline, the Rat Park study is flawed. Journalist Katie MacBride notes that Alexander had difficulty publishing the article in the 1980’s. This was most likely because of problems with the methodology and other important factors. For example, the mice’s ability to mate in Rat Park probably tainted the results. Plus, a different breed of mice was used in Alexander’s study compared to the original study. And, data from the study was lost, which could have affected the outcome.
“The Rat Park study undermined one popular misconception about addiction, that chemistry of drugs is the single most important factor,” MacBride wrote. “But instead of pushing the popular understanding forward, it merely replaced that misconception with a new one: that environment is the most important factor.”
As MacBride points out, “Addiction isn’t that simple.”
It should be noted that Alexander’s Rat Park experiment did not receive any real attention until 2008. This was almost 30 years after the study was conducted. And, he did not receive additional funding to continue with his work after his “revolutionary” conclusions. Could this be because Alexander’s research is junk science?
You can’t rely on inconclusive research to prove anything. Therefore, we don’t rely on the Rat Park study to prove that environment alone causes addiction.
Addiction is More Complicated Than a Simple Change of Environment
It would be awesome if Alexander and Hari’s explanation for the cause of compulsive drug use were true. If it were, a change of scenery could “cure” millions of addicted Americans. Give them some people to hang out with, put them in a cool new apartment, give them a few toys to play with, and WHAM-O! Their substance abuse problem would disappear instantaneously.
But, many people who are addicted to drugs make these kinds of changes only to be disappointed. They move great distances, get different jobs, and make new friends. They believe that a change in the external environment will somehow magically transform their inner circumstances. They want relief from the chaos they experience because of their substance abuse. And, they are willing to go to any lengths to get it.
Human Beings Aren’t Rats Who Live in Rat Park
The problem is – wherever you go, there you are. Thus, environment cannot be the sole cause of addiction. Human beings are very complex creatures. We cannot be compared to rats. Alexander’s research is notable. But, it raises more questions than it does provide answers.
Furthermore, Alexander’s claim that “people only become addicted when they cannot find anything better to live for” is false. Many loving parents, successful professionals, passionate visionaries, and respected community members become hooked on drugs and alcohol. They have plenty of “better things” to live for than the pipe, the needle, or the bottle. Nevertheless, they struggle with substance abuse anyway.
Hari’s Myth # 3: The Vietnam War Proves That Environment Causes Addiction
Hari discusses the Vietnam War to back up his claims that environment alone causes compulsive drug use, . He insists that it provides a parallel to the Rat Park experiment using human subjects.
Hari mentions the well-known fact that tens of thousands of U.S. soldiers got hooked on heroin while serving in combat. Americans were concerned that when they returned home, there were going to be hundreds of thousands of “junkies” on the streets. He goes on to say that the soldiers who were using “loads of heroin” were followed home and studied.
“It turns out, they didn’t go to rehab, they didn’t go into withdrawal. Ninety-five percent of them just stopped,” Hari said in his TED Talk.
This is simply just not true.
FACT: Soldiers Returning From Vietnam Needed Help To Get Off Heroin
Hari’s presentation of information about what happened to addicted Vietnam vets is not based in reality. He would like his readers and viewers to believe that combat veterans started using heroin because the war was so terrible (which may have been true) and that they quit using the stuff when they returned from war (without detoxing or going to rehab).
The idea here is that when “caged,” soldiers became addicted like the rats in the first experiment. When let out of their “cages” to return home, they simply didn’t need to use heroin anymore – kind of like the rats in Rat Park. Easy peezy, right? Wrong!
To stake his claim, Hari references a study published by Lee N. Robins in the Archives of General Psychiatry. The data provided in the study is quite contradictory to what Hari tells us.
According to Robins:
- Vietnam service members who used narcotics heavily for a considerable amount of time suffered the classic symptoms of withdrawal for at least several days.
- Three years after returning from combat, at least 12 percent of veterans who were addicted to heroin in Vietnam were addicted in the United States.
- A third of the U.S. soldiers who were addicted to narcotics in Vietnam went through detoxification while they were still enlisted.
- Fourteen percent of those who continued to use heroin when they returned to the U.S. went to drug rehab to get help.
Where is Hari getting his numbers? Clearly, heroin addiction was a very real experience for many soldiers in Vietnam. Those who quit the stuff while still enlisted experienced withdrawal. Many returned home and continued using. A considerable number went to rehab.
The heroin-addicted veterans who returned home from Vietnam needed help to get clean. A change in environment did not cure them as Hari says. Another myth demystified!
So, If Environment Doesn’t Cause Addiction, What Does?
We have discussed the points made by Johann Hari in Chasing the Scream. We’ve done our best to set the record straight. We disagree with Hari and Alexander’s theory that environment is the SOLE cause of addiction and have explained why we feel this way.
Let’s go deeper.
There is certainly a lot to be learned about what causes people to abuse substances. However, the most current research suggests that these are the most obvious contributing factors:
- Mental health disorders
- The disease of addiction
Let’s discuss each of these potential causes.
Environmental Factors Can Make Someone More Susceptible To Substance Abuse
Studies have shown that environment factors play a critical role in substance abuse. People who are raised in a dysfunctional environment are more likely to abuse mind-altering substances than those who aren’t.
Childhood lays the groundwork for adulthood. When children are brought up in a healthy and nurturing environment, they become emotionally stable individuals. This makes them less likely to abuse mind-altering substances. When children are abused, neglected, and mistreated, they are at risk for becoming addicted.
One study found that there is a direct interdependence between the family condition and the extent of individual substance abuse. According to the research, “drug addicts come mostly from incomplete and pathological families.”
The main family factors of addiction, according to the results obtained, are “family atmosphere, strength of family ties, sense of family happiness, structure of authority in the family, and alcoholism.” In families where there is warmth and love, children do not or rarely take drugs. Generally, addicts come from families where there is ill will and hostility. They have weaker family ties than do those who do not take drugs.
So, yes – environment definitely contributes to compulsive drug use.
What Role Do Genetics Play In Addiction?
There is significant research available that shows genetics are a contributing factor for addiction. The genes passed onto you by your mother and father determine if you are predisposed to having a substance abuse problem. This is a widely accepted fact. We won’t bog you down with a lot of scientific mumbo jumbo. But, if you enjoy reading about this subject, check out this study, “New Insights Into the Genetics of Addiction.”
Rather than talk to you about genome sequencing, here’s a story worth sharing:
Two brothers grew up with an alcoholic father. One brother became an alcoholic. When asked why he was an alcoholic, he would always answer, “Because my father was an alcoholic.” The other brother never drank a single drop of alcohol. When asked why he never drank, he always answered, “Because my father was an alcoholic.”
Both men were raised by the same alcoholic father. One brother explained that his alcoholism was caused by genetics. He was an alcoholic because his father was – it runs in the family, he argued. The other brother knew that alcoholism is genetic. He never took a drink because he didn’t want to run the risk of getting hooked like his dad. So, he chose to abstain from alcohol.
Want to watch a cool video about how genetics cause addiction? Check out this TED Talk:
The Relationship Between Mental Disorders and Substance Abuse
Those who suffer from mental health issues like bipolar disorder, schizophrenia, PTSD, or an anxiety disorder frequently abuse mind-altering substances. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), approximately 20 million Americans had a substance abuse problem in 2014. Of these, 7.9 million people had both a mental disorder and drug or alcohol problem. This is also known as a co-occuring disorder or dual-diagnosis.
It is very common for people who struggle with mental health problems to self-medicate with drugs or alcohol. They do this to find relief from painful symptoms. Mind-altering substances can have a numbing effect at first, which can offer some level of comfort.
However, over time, these substances stop working. Plus, they cause a person’s mental health to deteriorate. This makes symptoms even worse. So, someone with a mental disorder will become hooked on drugs or alcohol and become even sicker.
When someone has a mental health disorder, they are more likely to become addicted. This is because their brain’s biochemistry is already imbalanced. They are much more likely to become drug dependent than those who do not have a mental health diagnosis.
The Disease of Addiction – How It Affects Substance Abusers
We have talked about the role of genetics, environment, and mental health when it comes to compulsive drug use. However, there is one explanation above all else that accurately explains why some people become addicted and others don’t. When it comes to the root of addiction, we can simply say it is caused by disease. Of course, whether or not someone has this disease is determined by various factors (including the ones we have explained previously).
According to the National Institute on Addiction (NIDA), “Addiction is defined as a chronic, relapsing brain disease that is characterized by compulsive drug seeking and use, despite harmful consequences.” If left untreated, the disease is chronic, progressive, and fatal.
Most medical experts agree that this disease is the root cause of addiction. When someone is afflicted with this illness, they develop a mental obsession and physical compulsion to use mind-altering substances at all costs. They are not like “normal” people who can drink alcohol responsibly or take drugs recreationally.
Take a moment to watch a video where Michael Botticelli (the former director of National Drug Control Policy) explains the disease:
Many Believe Addiction Is Caused By Choice
Now that we have briefly discussed what probably causes people to become addicted, let’s talk about what doesn’t cause it: choice.
Those who do not understand what it is like to have a substance abuse problem insist that becoming hooked on drugs or alcohol is a choice. Ask any addicted person and they will tell you it feels like anything but.
Those who are hooked on drugs like cocaine, heroin, or crystal meth feel enslaved by their habit and want desperately to stop using. Nevertheless, after many attempts to quit on their own, someone with the disease of addiction will find that they simply cannot stop on sheer willpower.
Drug Use is a Choice, Addiction is Not
It is obvious that people choose to do drugs in the beginning. Many an addict has been born out of sheer curiosity. In these cases, a person started out with a desire to experiment with mind-altering substances. They wanted to know how they would make them feel. So, they got high.
First-time drug users may be influenced by peers or they may set out on their own to score through friends who use. No matter how it happens, using drugs for the very first time is almost always a choice. (There are instances, however, where people are coerced into using drugs by those who have sinister motives. “Breaking” women into the sex trade is a good example.)
No one becomes addicted by choice. There is a fine line between the curious and the furious. And, you never know which one you are until it’s too late.
The Difference Between The Curious and The Furious
There are those who are curious about drug use and those who are furious about it.
Someone who does not have the disease of addiction will try certain substances a few times and never do them again. Or, they might go through a phase where they take drugs or drink a lot of alcohol – college is a great example – but they ultimately grow out of it. They enjoy getting high for a period of time, but that time passes. They are curious. But, it stops there.
This is not true of the furious. These are the people who hit the ground running. They have the disease of addiction but they don’t know it. They try marijuana or alcohol, for example, and they love the way the stuff makes them feel. They start smoking or drinking regularly. Then, they graduate to harder drugs, which make them feel even more fantastic, so they use them even more compulsively.
In the case of the furious, there are various stages of addiction, which ultimately lead to a downward spiral. Their drug use gets completely out of control. They may experience negative consequences because of their substance abuse, but they continue to drink or drug anyway. In the end, they wind up in jail, rehab, or dead. This is the reality of what happens when the disease of addiction goes untreated.
The Science Behind Addiction – Debunking the Myth That It’s A Choice
According to NIDA, the initial decision to take drugs is usually voluntary. “However, with continued use, a person’s ability to exert self-control can become seriously impaired; this impairment in self-control is the hallmark of addiction.”
NIDA reports that brain imaging studies of people who are addicted reveal a lot about compulsive drug use. It “causes physical changes in areas of the brain that are critical to judgment, decision making, learning and memory, and behavior control.” Scientists say that these changes negatively impact the way the brain works. This may help explain the obsessive-compulsive cycle that accompanies addiction.
In short, someone may choose to use drugs at first. But, over time an addicted person loses their ability to choose. Their brain is essentially “hijacked” by the powerful effect of mind-altering chemicals. This limits an individual’s capacity to consistently carry out rational choices.
No Matter What Causes Addiction – Get Help If You’re Struggling With A Habit
As you’ve probably figured out after reading this article, there is still much debate about what causes addiction. Perhaps you believe Johann Hari and Bruce Alexander’s theory that substance abuse can be stopped with a simple change of environment. Maybe you’re convinced it’s a matter of genetics. Or, you might be willing to take the medical community at face value when it defines it as a disease. In reality – it doesn’t matter what causes addiction if you are addicted.
Sure, in the long run, we want to know without a doubt what’s really at the root of substance abuse. In pursuit of answers, medical discoveries could potentially open doors to create vaccines. These would prevent people from getting hooked on mind-altering substances in the first place. Or, scientists might find a pill or injection that could instantaneously cure the compulsive use of drugs.
For these reasons, it is beneficial to understand the scientific dynamics that drive a drug or alcohol problem. But, we’ll leave all that up to the brilliant researchers of the modern era!
In the meantime, we think the most important thing people should know about addiction is that help is available. No matter how bad things have gotten, there is hope. Addicted people everywhere can find healing and learn a new way to live. Recovery is possible.