Overcoming addiction: A social problem?

In his recent New Yorker interview, Joe Biden’s son, Hunter, disclosed a struggle with addiction spanning 10 failed attempts to stay sober, including inpatient rehab, outpatient programs, medications, hightech monitoring, yoga, meditation — virtually every treatment modality available. He is far from alone. The large majority of addicts relapse within one year. Why? Because, as new research shows, the key to this seemingly intractable problem isn’t psychological or pharmacological, it’s social.

Yavin Shaham and his lab group at the Baltimore-based NIDA Intramural Research Program found a reliable cure for addiction — at least for rats. Their research, reported recently in Nature Neuroscience, centers on rat addicts who had heroin or methamphetamine mainlined into the pleasure centers of their brains.

These rats, alone in their cages, could choose between pressing a lever for a hit of the drug and a lever that would deliver another rat to them for company. The rats, including those in the most heavily addicted subgroup, chose a playmate nearly 100% of the time, even if they weren’t ordinarily isolated and starved for company.

Remarkably, choosing and getting the immediate social reward of a playmate rewired the rats’ brains, preventing relapse. This is vital, as the scientists found cravings don’t “naturally” fade away as abstinence continues. In fact, they get worse weeks, months or even years after drug use ends.

Humans are much more social creatures than rats, and what constitutes a meaningful social reward for us is much more complex. Warm social bonds are essential to our well-being, while loneliness is excruciating. When we lack companionship and social status (which in our culture requires economic stability and employment), we lose our sense of self-worth and desperately seek relief from our pain.

In many places, jobs are scarce, but drugs and alcohol are plentiful. For the affluent, like Hunter Biden, a job that generates money but prevents the pursuit of one’s desired role in society can undermine self-respect (Mr. Biden was drawn to art and public service, but went into law, lobbying and business to support his family). In either case, addiction reinforces loneliness, pushing us further inside ourselves and making it difficult or impossible to maintain jobs and loving relationships. This increases self-loathing, trapping addicts in a vicious and often deadly cycle.

Rehab (for the less than 10% of addicts who can access it) provides structure and human contact for a few weeks — then addicts are released back into the same cages they started out in, often just as their cravings surge. Outpatient therapies typically end within a few months. Even with methadone or buprenorphine, long-term recovery eludes far too many. No one can get self-respect from a medication. Addiction is a chronic disorder, like diabetes, that is often fatal when treatment ends or is unavailable: 90,000 die annually.

But in Baltimore, a scientifically validated therapeutic workplace program has successfully treated addicted, unemployable adults. Developed by researchers at Johns Hopkins University School of Medicine, it enables even hardcore homeless addicts to maintain sobriety by offering them long-term, rewarding jobs in a desired profession. It begins with a training phase to teach basic skills, followed by employment. Participants are tested for drug use frequently and rewarded with higher pay the longer they remain abstinent.

In Tennessee, an entrepreneur named Tony Simpson decided to provide life skills and job training, then employment, to addicts leaving prison to help heal his drug-ravaged community. Of the first 23 participants, only one relapsed.

Each of these programs is a viable alternative to the cage of addiction, because each entails a sustained commitment to making their participants full, respected members of society in ways that are personally meaningful and satisfying. As with the rats, these social rewards alter us physiologically, protecting us from relapse — as long as they keep coming. On a large enough scale, therapeutic workplaces could save tens of thousands of lives, and they’re economically viable. Therapeutic workplaces largely pay for themselves, while addiction costs $700 million annually.

Nation-wide implementation of therapeutic workplace programs would improve the economy, heal communities, lower crime rates and save lives. Best of all, these programs can be started on any scale by any organization.

Still, to turn the addiction epidemic around we’ll need to redirect significant government funds from enforcement to employment. Until then, millions of us remain trapped in cages of despair with only a single lever to press for relief: the one for another hit of chemicals.

Ruth Bettelheim (ruthbettelheim.com) is a therapist, life coach and writer.