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Most People With Addiction Simply Grow Out of It: Why Is This Widely Denied?

Stashed in: Young Americans, Addiction, Brain, Awesome, Drugs!, life, Nutrition!, Marijuana, So you're saying there's a chance...., Context, Addiction, Neuroscience

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Addiction as a developmental disorder, NOT a progressive disease.

Fascinating theory.

Perhaps as we get older the chemicals in the brain associated with addiction reduce in scope and impact -- kind of how men lose testosterone as we age?

Btw, I never realized this:

According to large epidemiological studies, most people who have diagnosable addiction problems do so—without treatment. The early to mid-20s is also the period when the prefrontal cortex—the part of the brain responsible for good judgment and self-restraint—finally reaches maturity.

According to the American Society of Addiction Medicine, addiction is “a primary, chronic disease of brain reward, motivation, memory and related circuitry.” However, that’s not what the epidemiology of the disorder suggests. By age 35, half of all people who qualified for active alcoholism or addiction diagnoses during their teens and 20s no longer do, according to a study of over 42,000 Americans in a sample designed to represent the adult population.

The average cocaine addiction lasts four years, the average marijuana addiction lasts six years, and the average alcohol addiction is resolved within 15 years. Heroin addictions tend to last as long as alcoholism, but prescription opioid problems, on average, last five years. In these large samples, which are drawn from the general population, only a quarter of people who recover have ever sought assistance in doing so (including via 12-step programs). This actually makes addictions the psychiatric disorder with the highest odds of recovery.

I gotta admit, the article makes a very compelling case.

So why do so many people still see addiction as hopeless? One reason is a phenomenon known as “the clinician’s error,” which could also be known as the “journalist’s error” because it is so frequently replicated in reporting on drugs. That is, journalists and rehabs tend to see the extremes: Given the expensive and often harsh nature of treatment, if you can quit on your own you probably will. And it will be hard for journalists or treatment providers to find you.

Similarly, if your only knowledge of alcohol came from working in an ER on Saturday nights, you might start thinking that prohibition is a good idea. All you would see are overdoses, DTs, or car crash, rape or assault victims. You wouldn’t be aware of the patients whose alcohol use wasn’t causing problems. And so, although the overwhelming majority of alcohol users drink responsibly, your “clinical” picture of what the drug does would be distorted by the source of your sample of drinkers.

Treatment providers get a similarly skewed view of addicts: The people who keep coming back aren’t typical—they’re simply the ones who need the most help. Basing your concept of addiction only on people who chronically relapse creates an overly pessimistic picture.

This is one of many reasons why I prefer to see addiction as a learning or developmental disorder, rather than taking the classical disease view. If addiction really were a primary, chronic, progressive disease, natural recovery rates would not be so high and addiction wouldn’t have such a pronounced peak prevalence in young people.

But if addiction is seen as a disorder of development, its association with age makes a great deal more sense. The most common years for full onset of addiction are 19 and 20, which coincides with late adolescence, before cortical development is complete. In early adolescence, when the drug taking that leads to addiction by the 20s typically begins, the emotional systems involved in love and sex are coming online, before the cognitive systems that rein in risk-taking are fully active.

Taking drugs excessively at this time probably interferes with both biological and psychological development. The biological part is due to the impact of the drugs on the developing circuitry itself—but the psychological part is probably at least as important. If as a teen you don’t learn non-drug ways of soothing yourself through the inevitable ups and downs of relationships, you miss out on a critical period for doing so. Alternatively, if you do hone these skills in adolescence, even heavy use later may not be as hard to kick because you already know how to use other options for coping.

The data supports this idea: If you start drinking or taking drugs with peers before age 18, you have a 25% chance of becoming addicted, but if your use starts later, the odds drop to 4%. Very few people without a prior history of addiction get hooked later in life, even if they are exposed to drugs like opioid painkillers.

Interesting theory. I'm yet to be convinced entirely though, and I wonder also of his opinion on people addicted to e.g. food. I'm not sure I can confirm that the majority of people "grow out" of using --something-- to ease the pain and burden of living a human life (in my, albeit, limited experience).

I think he's specifically referring to use of hard drugs, which one can safely live without. 

Those drugs appeal to teenagers who have a "danger seeking" attitude.

As the danger seeking subsides, so does the addiction to drugs. Or so the evidence suggests. 

I disagree, the author (I think it's a she not a he!) specifically mentions alcohol and marijuana. I think in many cases the issue comes back to what a lot of articles on PandaWhale allude to: context is everything. Young people are all experimenting, and a few will go too far and find themselves in a jam. A few years later though, if the vast majority of your peer group has responsible jobs and meaningful relationships and positive life experiences like travel... even addicts often find themselves with fewer friends around to support their negative decisions. It might be that the most efficacious part of AA is just replacing your drinking and drugging buddies with a sober peer group!

In addition I believe that the brain's higher-order centers mature around the early 20s -- so you hopefully have new and more reliable internal sources of impulse control, judgment, intrinsic motivation, and long-term planning ability.

Food is a little different in my opinion Maria. No one NEEDS to take drugs or alcohol just to survive, but you do need to eat. And food is so deeply tied up with love, culture, belonging, nurturing, and all those things that go back to our very first moments of life... whereas drinking and drugs for most Americans are not encountered until the teenage years. That's what makes it seem so insidious to learn that big businesses manipulate the fat, salt, and sugar content of your foods to make them more addictive and harmful!

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