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Is addiction actually a kind of learning disorder? Maia Szalavitz in her book about addiction as a learning disorder, argues here that, fundamentally, addiction is a learning disorder. She is by no means the first to make this call. One just needs to Google the hypothesis and a ton of useful information leaps up at you and begs decent questions. There are three critical elements to it: the behaviour has a psychological purpose, the specific learning pathways involved make it become nearly automatic and compulsive, and it doesn’t stop when it is no longer adaptive. I will describe these in greater detail later.
First, I want to make clear that I am far from the first to characterize addiction as a learning disorder, or addiction as learned behavior. The idea that learning matters in addiction is uncontroversial and has been accepted by every type of scientist who studies the condition and by many of those who treat it for decades. There is no theory—from the “brain disease” posited by the National Institute on Drug Abuse, to the sociology of Alfred Lindesmith, Lee Robins, and Norman Zinberg, to the psychological approach favored by Stanton Peele—that says that learning is not involved. In fact, addiction pioneer Lindesmith wrote in his 1947 book, Addiction and Opiates, that “addiction is established in a learning process extending over a period of time.” Countless researchers and theorists—notably, Peele, Nora Volkow, Kent Berridge, Terry Robinson, Iain Brown, George Ainslie, Gene Heyman, Roy Wise, David Duncan, and Edward Khantzian—have made critical contributions to the conversation, some complementary and some conflicting with one another. Addiction as a learning disorder is hot on the conversation trail, as we slowly discover what addiction really entails. If anyone tells you that there is one, hard and fast approach to what addiction really is, they might just be part of the problem rather than the solution. I have met many such people who even run addiction centres, and or work at them, with the cultist and scary belief in “I know best, I’ve been there.” They you’re wrong and I’m right is a major problem with having people without degrees and proper training doing this kind of work.
But the implications of framing addiction as a learning disorder have received far less attention. This book is my attempt at a popular synthesis of these ideas, which offer insights for treatment, prevention, and overall drug policy. To start, I want to stress that I do not mean that there is no biology involved, nor do I mean to imply that medical treatment—including medication—is not often useful and sometimes critical. I also don’t mean to imply that addiction is driven by ignorance. The problem with our current understanding of addiction is that by ignoring the role of learning, we have tried to slot it into a category of medical illness or moral failing where it doesn’t quite fit and then tried to ignore the round peg forced into the square hole.
Our society doesn’t deal well with conditions that cross boundaries between mind and body, medicine and education, psychology and psychiatry, psychiatry and neurology. Instead, we tend to ignore the aspects of the disorder that don’t fit our preferred view rather than recognize this complexity. Consider the endless controversies over medication versus therapy for depression or the ongoing fight over whether ADHD is real or simply a case of schools failing children with excess energy. Consider the difficulty parents have in determining whether to call a doctor, a tutor, or a therapist when a child has ongoing behavior problems that affect academic achievement. Consider the ongoing battle over whether any mental illnesses even exist or are simply cultural designations of deviance.
Too often discussions in this area become semantic battles that push stigma around: my condition is neurological while yours is psychiatric; my kid has a brain disease but yours has a developmental disability. In the addictions world, the word disease itself is an ideological front line, weighed down with far too much historical and moral baggage. I’d like to stop fighting over language (if you want to say it’s both addiction as a learning disorder and a disease, I won’t try to stop you, nor do I mind if you want to see these notions as completely distinct). Instead, I want to focus on how learning and development can allow us to stop trying to square circles.
From this perspective, like schizophrenia, depression, and autism, addiction has neuro-developmental roots: some brains are more vulnerable to it than others as a result of genetic predispositions, which affect development in utero and beyond. Predispositions to addiction also tend to carry risk of other mental illnesses and developmental disorders: at least half of people with addictions also have another condition, like depression, anxiety disorders, bipolar, ADHD, and schizophrenia, with some studies finding rates of co-occurring disorders as high as 98%; and around 50% of people with one type of addictive behaviour also engage in others. All of these propensities interact with early life experience, particularly trauma, over time to produce risk. Addiction doesn’t just appear; it unfolds!
Article adapted from, A history of addiction, by Maia Szalavitz. For more information on the subject purchase the book, it is well worth a read. Food for thought? For more information about addiction as a learning disorder, depression or general addiction, contact Pathways Plett Rehab and Wellness Centre. We are here to help wherever we can. Changing lives, regardless of the presenting problem, is what we do! info@pathwaysplettrehab.co.za