Tuesday, March 28, 2017

drug and alcohol treatment

drug and alcohol treatment

one of my earliest memories is of trying to wake upone of my relatives and not being able to. and i was just a little kid,so i didn't really understand why, but as i got older, i realized we haddrug addiction in my family, including later cocaine addiction. i'd been thinking about it a lot lately,partly because it's now exactly 100 years since drugs were first bannedin the united states and britain, and we then imposed thaton the rest of the world.

it's a century since we madethis really fateful decision to take addicts and punish themand make them suffer, because we believed that would deter them;it would give them an incentive to stop. and a few years ago, i was looking atsome of the addicts in my life who i love, and trying to figure outif there was some way to help them. and i realized there were loadsof incredibly basic questions i just didn't know the answer to, like, what really causes addiction? why do we carry on with this approachthat doesn't seem to be working,

and is there a better way out therethat we could try instead? so i read loads of stuff about it, and i couldn't really findthe answers i was looking for, so i thought, okay, i'll go and sitwith different people around the world who lived this and studied this and talk to them and seeif i could learn from them. and i didn't realize i would end upgoing over 30,000 miles at the start, but i ended up going and meetingloads of different people, from a transgender crack dealerin brownsville, brooklyn,

to a scientist who spends a lot of timefeeding hallucinogens to mongooses to see if they like them -- it turns out they do, but onlyin very specific circumstances -- to the only country that's everdecriminalized all drugs, from cannabis to crack, portugal. and the thing i realizedthat really blew my mind is, almost everything we thinkwe know about addiction is wrong, and if we start to absorbthe new evidence about addiction, i think we're going to have to changea lot more than our drug policies.

but let's start with what we thinkwe know, what i thought i knew. let's think about this middle row here. imagine all of you, for 20 days now, wentoff and used heroin three times a day. some of you look a little moreenthusiastic than others at this prospect. (laughter) don't worry,it's just a thought experiment. imagine you did that, right? what would happen? now, we have a story about what wouldhappen that we've been told for a century.

we think, because there arechemical hooks in heroin, as you took it for a while, your body would becomedependent on those hooks, you'd start to physically need them, and at the end of those 20 days,you'd all be heroin addicts. right? that's what i thought. first thing that alerted me to the factthat something's not right with this story is when it was explained to me. if i step out of this ted talk todayand i get hit by a car and i break my hip,

i'll be taken to hospitaland i'll be given loads of diamorphine. diamorphine is heroin. it's actually much better herointhan you're going to buy on the streets, because the stuff you buyfrom a drug dealer is contaminated. actually, very little of it is heroin, whereas the stuff you getfrom the doctor is medically pure. and you'll be given it for quitea long period of time. there are loads of people in this room, you may not realize it,you've taken quite a lot of heroin.

and anyone who is watching thisanywhere in the world, this is happening. and if what we believeabout addiction is right -- those people are exposedto all those chemical hooks -- what should happen?they should become addicts. this has been studied really carefully. it doesn't happen; you will have noticedif your grandmother had a hip replacement, she didn't come out as a junkie.(laughter) and when i learned this,it seemed so weird to me, so contrary to everything i'd been told,everything i thought i knew,

i just thought it couldn't be right,until i met a man called bruce alexander. he's a professorof psychology in vancouver who carried out an incredible experiment i think really helps usto understand this issue. professor alexander explained to me, the idea of addiction we've allgot in our heads, that story, comes partly from a series of experiments that were done earlierin the 20th century. they're really simple.

you can do them tonight at homeif you feel a little sadistic. you get a rat and you put it in a cage,and you give it two water bottles: one is just water, and the other is waterlaced with either heroin or cocaine. if you do that, the rat will almost alwaysprefer the drug water and almost alwayskill itself quite quickly. so there you go, right?that's how we think it works. in the '70s, professor alexander comesalong and he looks at this experiment and he noticed something. he said ah, we're puttingthe rat in an empty cage.

it's got nothing to doexcept use these drugs. let's try something different. so professor alexander built a cagethat he called "rat park," which is basically heaven for rats. they've got loads of cheese,they've got loads of colored balls, they've got loads of tunnels. crucially, they've got loads of friends.they can have loads of sex. and they've got both the water bottles,the normal water and the drugged water. but here's the fascinating thing:

in rat park, they don'tlike the drug water. they almost never use it. none of them ever use it compulsively. none of them ever overdose. you go from almost 100 percent overdosewhen they're isolated to zero percent overdose when theyhave happy and connected lives. now, when he first saw this,professor alexander thought, maybe this is just a thing about rats,they're quite different to us. maybe not as different as we'd like,but, you know --

but fortunately, there wasa human experiment into the exact same principle happeningat the exact same time. it was called the vietnam war. in vietnam, 20 percent of all americantroops were using loads of heroin, and if you look at the newsreports from the time, they were really worried, becausethey thought, my god, we're going to have hundreds of thousands of junkieson the streets of the united states when the war ends; it made total sense. now, those soldiers who were usingloads of heroin were followed home.

the archives of general psychiatrydid a really detailed study, and what happened to them? it turns out they didn't go to rehab.they didn't go into withdrawal. ninety-five percent of them just stopped. now, if you believe the storyabout chemical hooks, that makes absolutely no sense,but professor alexander began to think there might be a differentstory about addiction. he said, what if addiction isn'tabout your chemical hooks? what if addiction is about your cage?

what if addiction is an adaptationto your environment? looking at this, there was another professorcalled peter cohen in the netherlands who said, maybe we shouldn'teven call it addiction. maybe we should call it bonding. human beings have a naturaland innate need to bond, and when we're happy and healthy,we'll bond and connect with each other, but if you can't do that, because you're traumatized or isolatedor beaten down by life,

you will bond with somethingthat will give you some sense of relief. now, that might be gambling,that might be pornography, that might be cocaine,that might be cannabis, but you will bond and connectwith something because that's our nature. that's what we want as human beings. and at first, i found this quitea difficult thing to get my head around, but one way that helped meto think about it is, i can see, i've got over by my seata bottle of water, right? i'm looking at lots of you, and lotsof you have bottles of water with you.

forget the drugs. forget the drug war. totally legally, all of those bottlesof water could be bottles of vodka, right? we could all be getting drunk --i might after this -- (laughter) -- but we're not. now, because you've been able to affordthe approximately gazillion pounds that it costs to get into a ted talk,i'm guessing you guys could afford to be drinking vodkafor the next six months. you wouldn't end up homeless. you're not going to do that,and the reason you're not going to do that

is not because anyone's stopping you. it's because you've gotbonds and connections that you want to be present for. you've got work you love.you've got people you love. you've got healthy relationships. and a core part of addiction, i came to think, and i believethe evidence suggests, is about not being able to bearto be present in your life. now, this has reallysignificant implications.

the most obvious implicationsare for the war on drugs. in arizona, i went outwith a group of women who were made to wear t-shirtssaying, "i was a drug addict," and go out on chain gangs and dig graveswhile members of the public jeer at them, and when those women get out of prison,they're going to have criminal records that mean they'll never workin the legal economy again. now, that's a very extreme example,obviously, in the case of the chain gang, but actually almosteverywhere in the world we treat addicts to some degree like that.

we punish them. we shame them.we give them criminal records. we put barriers between them reconnecting. there was a doctor in canada,dr. gabor matã©, an amazing man, who said to me, if you wanted to designa system that would make addiction worse, you would design that system. now, there's a place that decidedto do the exact opposite, and i went there to see how it worked. in the year 2000, portugal hadone of the worst drug problems in europe. one percent of the population was addictedto heroin, which is kind of mind-blowing,

and every year, they triedthe american way more and more. they punished people and stigmatized themand shamed them more, and every year, the problem got worse. and one day, the prime minister andthe leader of the opposition got together, and basically said, look, we can't go on with a country where we're havingever more people becoming heroin addicts. let's set up a panelof scientists and doctors to figure out what wouldgenuinely solve the problem. and they set up a panel led byan amazing man called dr. joã£o goulã£o,

to look at all this new evidence, and they came back and they said, "decriminalize all drugsfrom cannabis to crack, but" -- and this is the crucial next step -- "take all the money we used to spendon cutting addicts off, on disconnecting them, and spend it insteadon reconnecting them with society." and that's not really what we think ofas drug treatment in the united states and britain.

so they do do residential rehab, they do psychological therapy,that does have some value. but the biggest thing they didwas the complete opposite of what we do: a massive programof job creation for addicts, and microloans for addictsto set up small businesses. so say you used to be a mechanic. when you're ready, they'll goto a garage, and they'll say, if you employ this guy for a year,we'll pay half his wages. the goal was to make surethat every addict in portugal

had something to get outof bed for in the morning. and when i went and met the addictsin portugal, what they said is,as they rediscovered purpose, they rediscovered bondsand relationships with the wider society. it'll be 15 years this yearsince that experiment began, and the results are in: injecting drug use is down in portugal, according to the britishjournal of criminology, by 50 percent, five-zero percent.

overdose is massively down,hiv is massively down among addicts. addiction in every studyis significantly down. one of the ways you know it's workedso well is that almost nobody in portugal wants to go back to the old system. now, that's the political implications. i actually think there's a layerof implications to all this research below that. we live in a culture where peoplefeel really increasingly vulnerable to all sorts of addictions,whether it's to their smartphones

or to shopping or to eating. before these talks began --you guys know this -- we were told we weren't allowedto have our smartphones on, and i have to say, a lot of youlooked an awful lot like addicts who were told their dealerwas going to be unavailable for the next couple of hours. (laughter) a lot of us feel like that,and it might sound weird to say, i've been talking about how disconnectionis a major driver of addiction and weird to say it's growing,

because you think we're the most connectedsociety that's ever been, surely. but i increasingly began to thinkthat the connections we have or think we have, are like a kindof parody of human connection. if you have a crisis in your life,you'll notice something. it won't be your twitter followerswho come to sit with you. it won't be your facebook friendswho help you turn it round. it'll be your flesh and blood friendswho you have deep and nuanced and textured, face-to-facerelationships with, and there's a study i learned about frombill mckibben, the environmental writer,

that i think tells us a lot about this. it looked at the number of close friendsthe average american believes they can call on in a crisis. that number has been decliningsteadily since the 1950s. the amount of floor spacean individual has in their home has been steadily increasing, and i think that's like a metaphor for the choice we've made as a culture. we've traded floorspace for friends,we've traded stuff for connections,

and the result is we are one of theloneliest societies there has ever been. and bruce alexander, the guy who didthe rat park experiment, says, we talk all the time in addictionabout individual recovery, and it's right to talk about that, but we need to talk much moreabout social recovery. something's gone wrong with us,not just with individuals but as a group, and we've created a society where,for a lot of us, life looks a whole lot morelike that isolated cage and a whole lot less like rat park.

if i'm honest, this isn'twhy i went into it. i didn't go in to the discoverthe political stuff, the social stuff. i wanted to know how to helpthe people i love. and when i came back from thislong journey and i'd learned all this, i looked at the addicts in my life, and if you're really candid,it's hard loving an addict, and there's going to be lots of peoplewho know in this room. you are angry a lot of the time, and i think one of the reasonswhy this debate is so charged

is because it runs through the heartof each of us, right? everyone has a bit of themthat looks at an addict and thinks, i wish someone would just stop you. and the kind of scripts we're told for howto deal with the addicts in our lives is typified by, i think, the reality show "intervention,"if you guys have ever seen it. i think everything in our livesis defined by reality tv, but that's another ted talk. if you've ever seenthe show "intervention,"

it's a pretty simple premise. get an addict, all the peoplein their life, gather them together, confront them with what they're doing,and they say, if you don't shape up, we're going to cut you off. so what they do is they takethe connection to the addict, and they threaten it,they make it contingent on the addict behaving the way they want. and i began to think, i began to seewhy that approach doesn't work, and i began to think that's almost likethe importing of the logic of the drug war

into our private lives. so i was thinking,how could i be portuguese? and what i've tried to do now,and i can't tell you i do it consistently and i can't tell you it's easy, is to say to the addicts in my life that i want to deepenthe connection with them, to say to them, i love youwhether you're using or you're not. i love you, whatever state you're in, and if you need me,i'll come and sit with you

because i love you and i don'twant you to be alone or to feel alone. and i think the core of that message -- you're not alone, we love you -- has to be at every levelof how we respond to addicts, socially, politically and individually. for 100 years now, we've been singingwar songs about addicts. i think all along we should have beensinging love songs to them, because the opposite of addictionis not sobriety.

the opposite of addiction is connection. thank you. (applause)

No comments:

Post a Comment