Stop telling me ‘Everything you think you know about addiction is wrong’

You may have heard Johann Hari declare that ‘everything we think we know about addiction is wrong’ in his Ted talk of the same name (with nearly 4 million views), or his Huffington post article ambitiously titled “The Likely Cause of Addiction Has Been Discovered, and It Is Not What You Think”. Hari emphasizes the need to move away from punishing individuals struggling with addiction and work on compassion and establishing meaningful human connections. Although this is a good message, the talk as a whole is deeply misguided, and filled with inaccurate, overly simplified and categorical information that is misleading. This is largely because Hari is a journalist by training and not a scientist or addiction specialist. Unfortunately he dismisses decades of important research into the neurobiological and genetic components of addiction (Goldman et al., 2005; Koob & Volkow, 2010).

He conjectures that environment and a lack of human connection are to blame for addiction, citing Bruce Alexander’s Rat Park experiment and the return of veterans from the Vietnam War. Few who have experienced addiction or worked in the field would discount the significant role of environment, however it is reckless to discount decades of research in to its biological components. His primary evidence, the Rat Park experiment – which simply put, demonstrated that when morphine-addicted rats were placed in enriched environments they would not drink morphine-laced water – has never been replicated and does nothing to refute neuroimaging research showing that long lasting impairments in decision-making are still present long after abstinence has been achieved (Goldstein & Volkow, 2011). Hari also implies Vietnam veterans came home and easily ceased using heroin, failing to mention that all returning soldiers had to complete urine screens and, if necessary, detoxification before returning to the United States. In addition, he fails to acknowledge that potential soldiers with mental illness were not drafted (Robins et al., 2010). This is extremely important given that concurrent psychiatric illness is very prevalent among heroin users, and is often a key predictor of failure to improve from treatment (Coupland et al., 2014).

The most surprising moment of Hari’s talk, however, is when he argues that if addiction was strongly rooted in biology, people who are given painkillers post-surgery or after an injury would become addicted; “you will have noticed if your grandmother had a hip replacement, she didn’t come out as a junkie”. You can only conclude that Johann Hari is clearly unfamiliar with the ongoing prescription opioid epidemic which in 2014 claimed the lives of nearly 20,000 people in the United States alone (NIH, 2015). This does not reflect well on Hari’s evaluation of the scientific literature, or his three and a half year, 30,000-mile journey to better understand addiction.

Johan Hari’s work on addiction is a good example of the dangers of a little bit of knowledge. He makes unsubstantiated, sweeping statements without any critical appraisal of his own conclusions. It is dangerous to preach such a restrictive ideology about what is likely one of the world’s most multi-dimensional public health issues. Ignoring the biological aspect of addiction will only serve to limit the insight and understanding of those struggling with drug and alcohol abuse. What do you think?

 

References
Coupland, S., Fraser, R., Palaciox-Boix, J., Charney, D.A., Negrete, J.C., Gill, K.J. (2014). Illicit and Prescription Opiate Dependence: The Impact of Axis II Psychiatric Comorbidity on Detoxification Outcome. J Addict Res Ther. S10:008. doi: 10.4172/2155-6105.S10-008

Goldman D, Oroszi G, Ducci F. (2005). The genetics of addictions: uncovering the genes. Nat Rev Genet. 6(7):521-32.

Goldstein RZ, Volkow ND. (2011). Dysfunction of the prefrontal cortex in addiction: neuroimaging findings and clinical implications. Nat Rev Neurosci. 12(11):652-69. doi: 10.1038/nrn3119.

Hari, Johann. (2015). Everything you think you know about addiction is wrong. Retrieved from https://www.ted.com/talks/johann_hari_everything_you_think_you_know_about_addiction_is_wrong?language=en

Koob GF, Volkow ND. (2010). Neurocircuitry of addiction. Neuropsychopharmacology. 35(1):217-38. doi: 10.1038/npp.2009.110.

National Institute on Drug Abuse (NIH). (2015). Overdose Death Rates. Retrieved from http://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates

Robins LN, Helzer JE, Hesselbrock M, Wish E. (2010). Vietnam veterans three years after Vietnam: how our study changed our view of heroin. Am J Addict. 19(3):203-11. doi: 10.1111/j.1521-391.2010.00046.x.

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