Everything you think you know about addiction is wrong | Johann Hari | TED

0:12 One of my earliest memories is of trying to wake

0:15 up one of my relatives and not being able to.

0:17 And I was just a little kid, so I didn't really understand why,

0:20 but as I got older, I realized we had drug addiction in my family,

0:23 including later cocaine addiction.

0:25 I'd been thinking about it a lot lately,

0:28 partly because it's now exactly 100 years since drugs

0:31 were first banned in the United States and Britain,

0:33 and we then imposed that on the rest of the world.

0:36 It's a century since we made this really fateful decision

0:39 to take addicts and punish them and make them suffer,

0:43 because we believed that would deter them;

0:45 it would give them an incentive to stop.

0:48 And a few years ago, I was looking at some of the addicts in my life who I love,

0:53 and trying to figure out if there was some way to help them.

0:56 And I realized there were loads of incredibly basic

0:59 questions I just didn't know the answer to, like, what really causes addiction?

1:04 Why do we carry on with this approach that doesn't seem to be working,

1:07 and is there a better way out there that we could try instead?

1:10 So I read loads of stuff about it,

1:12 and I couldn't really find the answers I was looking for, so I thought, okay,

1:15 I'll go and sit with different people

1:17 around the world who lived this and studied

1:19 this and talk to them and see if I could learn from them.

1:22 And I didn't realize I would end up going over 30,000 miles at the start,

1:26 but I ended up going and meeting loads of different people,

1:29 from a transgender crack dealer in Brownsville, Brooklyn,

1:31 to a scientist who spends a lot of time feeding hallucinogens

1:34 to mongooses to see if they like them— it turns out they do,

1:38 but only in very specific circumstances—

1:39 to the only country that's ever decriminalized all drugs,

1:42 from cannabis to crack, Portugal.

1:45 And the thing I realized that really blew my mind is,

1:47 almost everything we think we know about addiction is wrong,

1:51 and if we start to absorb the new evidence about addiction,

1:54 I think we're going to have to change a lot more than our drug policies.

1:58 But let's start with what we think we know, what I thought I knew.

2:01 Let's think about this middle row here.

2:03 Imagine all of you, for 20 days now, went off and used heroin three times a day.

2:07 Some of you look a little more enthusiastic than others at this prospect.

2:10 (Laughter) Don't worry, it's just a thought experiment.

2:14 Imagine you did that, right?

2:16 What would happen?

2:17 Now, we have a story about what would happen that we've been told for a century.

2:21 We think, because there are chemical hooks in heroin,

2:23 as you took it for a while, your body would become dependent on those hooks,

2:28 you'd start to physically need them,

2:29 and at the end of those 20 days, you'd all be heroin addicts.

2:33 Right?

2:33 That's what I thought.

2:34 First thing that alerted me to the fact that something's not

2:37 right with this story is when it was explained to me.

2:40 If I step out of this TED Talk today and I get hit by a car and I break my hip,

2:43 I'll be taken to hospital and I'll be given loads of diamorphine.

2:47 Diamorphine is heroin.

2:48 It's actually much better heroin than you're going to buy on the streets,

2:52 because the stuff you buy from a drug dealer is contaminated.

2:55 Actually, very little of it is heroin,

2:57 whereas the stuff you get from the doctor is medically pure.

2:59 And you'll be given it for quite a long period of time.

3:02 There are loads of people in this room,

3:04 you may not realize it, you've taken quite a lot of heroin.

3:07 And anyone who is watching this anywhere in the world, this is happening.

3:10 And if what we believe about addiction is right— those people

3:13 are exposed to all those chemical hooks— What should happen?

3:16 They should become addicts.

3:18 This has been studied really carefully.

3:20 It doesn't happen; you will have noticed

3:22 if your grandmother had a hip replacement, she didn't come out as a junkie.

3:25 (Laughter) And when I learned this, it seemed so weird to me,

3:29 so contrary to everything I'd been told,

3:31 everything I thought I knew, I just thought it couldn't be right,

3:34 until I met a man called Bruce Alexander.

3:36 He's a professor of psychology in Vancouver who carried out

3:40 an incredible experiment I think really helps us to understand this issue.

3:43 Professor Alexander explained to me,

3:45 the idea of addiction we've all got in our heads,

3:48 that story, comes partly from a series of experiments

3:50 that were done earlier in the 20th century.

3:52 They're really simple.

3:54 You can do them tonight at home if you feel a little sadistic.

3:57 You get a rat and you put it in a cage, and you give it two water bottles:

4:00 One is just water, and the other is water laced with either heroin or cocaine.

4:04 If you do that, the rat will almost always prefer

4:06 the drug water and almost always kill itself quite quickly.

4:09 So there you go, right?

4:10 That's how we think it works.

4:12 In the '70s, Professor Alexander comes along and he

4:14 looks at this experiment and he noticed something.

4:17 He said ah, we're putting the rat in an empty cage.

4:19 It's got nothing to do except use these drugs.

4:21 Let's try something different.

4:23 So Professor Alexander built a cage that he

4:25 called "Rat Park," which is basically heaven for rats.

4:28 They've got loads of cheese,

4:30 they've got loads of colored balls, they've got loads of tunnels.

4:33 Crucially, they've got loads of friends.

4:34 They can have loads of sex.

4:36 And they've got both the water bottles, the normal water and the drugged water.

4:41 But here's the fascinating thing: In Rat Park, they don't like the drug water.

4:47 They almost never use it.

4:49 None of them ever use it compulsively.

4:51 None of them ever overdose.

4:53 You go from almost 100 percent overdose when they're isolated

4:56 to zero percent overdose when they have happy and connected lives.

4:59 Now, when he first saw this, Professor Alexander thought,

5:03 maybe this is just a thing about rats, they're quite different to us.

5:06 Maybe not as different as we'd like, but, you know— But fortunately,

5:09 there was a human experiment into the exact

5:11 same principle happening at the exact same time.

5:14 It was called the Vietnam War.

5:16 In Vietnam, 20 percent of all American troops were using loads of heroin,

5:20 and if you look at the news reports from the time, they were really worried,

5:24 because they thought, my God,

5:26 we're going to have hundreds of thousands of junkies

5:28 on the streets of the United States when the war ends; it made total sense.

5:32 Now, those soldiers who were using loads of heroin were followed home.

5:35 The Archives of General Psychiatry did a really detailed study,

5:38 and what happened to them?

5:40 It turns out they didn't go to rehab.

5:42 They didn't go into withdrawal.

5:44 Ninety-five percent of them just stopped.

5:47 Now, if you believe the story about chemical hooks,

5:49 that makes absolutely no sense, but Professor Alexander began to think there

5:53 might be a different story about addiction.

5:55 He said, what if addiction isn't about your chemical hooks?

5:58 What if addiction is about your cage?

6:01 What if addiction is an adaptation to your environment?

6:04 Looking at this, there was another professor

6:06 called Peter Cohen in the Netherlands who said,

6:09 maybe we shouldn't even call it addiction.

6:11 Maybe we should call it bonding.

6:12 Human beings have a natural and innate need to bond,

6:15 and when we're happy and healthy, we'll bond and connect with each other,

6:19 but if you can't do that, because you're

6:22 traumatized or isolated or beaten down by life,

6:25 you will bond with something that will give you some sense of relief.

6:29 Now, that might be gambling, that might be pornography, that might be cocaine,

6:32 that might be cannabis,

6:33 but you will bond and connect with something because that's our nature.

6:37 That's what we want as human beings.

6:40 And at first, I found this quite a difficult thing to get my head around,

6:43 but one way that helped me to think about it is,

6:46 I can see, I've got over by my seat a bottle of water, right?

6:49 I'm looking at lots of you, and lots of you have bottles of water with you.

6:53 Forget the drugs.

6:54 Forget the drug war.

6:55 Totally legally, all of those bottles of water could be bottles of vodka, right?

6:59 We could all be getting drunk— I might after this— (Laughter)— but we're not.

7:04 Now, because you've been able to afford the approximately gazillion

7:07 pounds that it costs to get into a TED Talk,

7:10 I'm guessing you guys could afford to be drinking vodka for the next six months.

7:13 You wouldn't end up homeless.

7:15 You're not going to do that, and the reason you're

7:18 not going to do that is not because anyone's stopping you.

7:21 It's because you've got bonds and connections that you want to be present for.

7:25 You've got work you love.

7:26 You've got people you love.

7:27 You've got healthy relationships.

7:29 And a core part of addiction,

7:32 I came to think, and I believe the evidence suggests,

7:34 is about not being able to bear to be present in your life.

7:38 Now, this has really significant implications.

7:41 The most obvious implications are for the War on Drugs.

7:44 In Arizona, I went out with a group

7:47 of women who were made to wear t-shirts saying,

7:50 "I was a drug addict," and go out on chain gangs

7:53 and dig graves while members of the public jeer at them,

7:56 and when those women get out of prison,

7:58 they're going to have criminal records that mean

8:00 they'll never work in the legal economy again.

8:02 Now, that's a very extreme example, obviously, in the case of the chain gang,

8:06 but actually almost everywhere in the world

8:08 we treat addicts to some degree like that.

8:10 We punish them.

8:11 We shame them.

8:12 We give them criminal records.

8:13 We put barriers between them reconnecting.

8:16 There was a doctor in Canada, Dr.

8:18 Gabor Maté, an amazing man, who said to me,

8:20 if you wanted to design a system that would make addiction worse,

8:23 you would design that system.

8:24 Now, there's a place that decided to do the exact opposite,

8:27 and I went there to see how it worked.

8:29 In the year 2000, Portugal had one of the worst drug problems in Europe.

8:33 One percent of the population was addicted to heroin,

8:35 which is kind of mind-blowing,

8:36 and every year, they tried the American way more and more.

8:39 They punished people and stigmatized them and shamed them more,

8:42 and every year, the problem got worse.

8:44 And one day, the Prime Minister and the leader

8:46 of the opposition got together, and basically said,

8:49 look, we can't go on with a country

8:51 where we're having ever more people becoming heroin addicts.

8:53 Let's set up a panel of scientists and doctors

8:56 to figure out what would genuinely solve the problem.

8:58 And they set up a panel led by an amazing man called Dr.

9:01 João Goulão, to look at all this new evidence, and they came back and they said,

9:05 "Decriminalize all drugs from cannabis to crack,

9:08 but"— and this is the crucial next step— "take all

9:12 the money we used to spend on cutting addicts off, on disconnecting them,

9:16 and spend it instead on reconnecting them with society." And that's not really

9:22 what we think of as drug treatment in the United States and Britain.

9:26 So they do do residential rehab,

9:28 they do psychological therapy, that does have some value.

9:31 But the biggest thing they did was the complete opposite of what we do:

9:34 a massive program of job creation for addicts,

9:37 and microloans for addicts to set up small businesses.

9:39 So say you used to be a mechanic.

9:41 When you're ready, they'll go to a garage, and they'll say,

9:44 if you employ this guy for a year, we'll pay half his wages.

9:47 The goal was to make sure that every addict in Portugal

9:50 had something to get out of bed for in the morning.

9:52 And when I went and met the addicts in Portugal, what they said is,

9:56 as they rediscovered purpose,

9:57 they rediscovered bonds and relationships with the wider society.

10:01 It'll be 15 years this year since that experiment began,

10:03 and the results are in: injecting drug use is down in Portugal,

10:07 according to the British Journal of Criminology,

10:09 by 50 percent, five-zero percent.

10:12 Overdose is massively down, HIV is massively down among addicts.

10:16 Addiction in every study is significantly down.

10:18 One of the ways you know it's worked so well is

10:21 that almost nobody in Portugal wants to go back to the old system.

10:24 Now, that's the political implications.

10:26 I actually think there's a layer

10:28 of implications to all this research below that.

10:30 We live in a culture where people feel

10:33 really increasingly vulnerable to all sorts of addictions,

10:35 whether it's to their smartphones or to shopping or to eating.

10:38 Before these talks began— you guys know this— we were told we

10:41 weren't allowed to have our smartphones on, and I have to say,

10:44 a lot of you looked an awful lot like addicts who were told

10:47 their dealer was going to be unavailable for the next couple of hours.

10:50 (Laughter) A lot of us feel like that, and it might sound weird to say,

10:53 I've been talking about how disconnection is a major

10:56 driver of addiction and weird to say it's growing,

10:58 because you think we're the most connected society that's ever been, surely.

11:02 But I increasingly began to think that the connections we have or think we have,

11:06 are like a kind of parody of human connection.

11:08 If you have a crisis in your life, you'll notice something.

11:11 It won't be your Twitter followers who come to sit with you.

11:14 It won't be your Facebook friends who help you turn it round.

11:17 It'll be your flesh and blood friends

11:18 who you have deep and nuanced and textured,

11:21 face-to-face relationships with, and there's a study

11:24 I learned about from Bill McKibben,

11:26 the environmental writer, that I think tells us a lot about this.

11:29 It looked at the number of close friends the average

11:32 American believes they can call on in a crisis.

11:34 That number has been declining steadily since the 1950s.

11:37 The amount of floor space an individual

11:39 has in their home has been steadily increasing,

11:42 and I think that's like a metaphor for the choice we've made as a culture.

11:46 We've traded floorspace for friends, we've traded stuff for connections,

11:51 and the result is we are one of the loneliest societies there has ever been.

11:54 And Bruce Alexander, the guy who did the Rat Park experiment,

11:57 says, we talk all the time in addiction about individual recovery,

12:01 and it's right to talk about that, but we

12:04 need to talk much more about social recovery.

12:06 Something's gone wrong with us, not just with individuals but as a group,

12:09 and we've created a society where, for a lot of us, life looks a whole lot more

12:13 like that isolated cage and a whole lot less like Rat Park.

12:16 If I'm honest, this isn't why I went into it.

12:19 I didn't go in to the discover the political stuff, the social stuff.

12:23 I wanted to know how to help the people I love.

12:25 And when I came back from this long journey and I'd

12:28 learned all this, I looked at the addicts in my life,

12:31 and if you're really candid, it's hard loving an addict,

12:36 and there's going to be lots of people who know in this room.

12:39 You are angry a lot of the time,

12:41 and I think one of the reasons why this debate is so

12:44 charged is because it runs through the heart of each of us, right?

12:48 Everyone has a bit of them that looks at an addict and thinks,

12:51 I wish someone would just stop you.

12:52 And the kind of scripts we're told for how to deal

12:55 with the addicts in our lives is typified by, I think,

12:57 the reality show "Intervention," if you guys have ever seen it.

13:00 I think everything in our lives is defined by reality TV,

13:03 but that's another TED Talk.

13:04 If you've ever seen the show "Intervention," it's a pretty simple premise.

13:08 Get an addict, all the people in their life,

13:10 gather them together, confront them with what they're doing,

13:13 and they say, if you don't shape up, we're going to cut you off.

13:16 So what they do is they take the connection to the addict, and they threaten it,

13:20 they make it contingent on the addict behaving the way they want.

13:24 And I began to think, I began to see why that approach doesn't work,

13:27 and I began to think that's almost like the importing

13:30 of the logic of the Drug War into our private lives.

13:34 So I was thinking, how could I be Portuguese?

13:37 And what I've tried to do now,

13:39 and I can't tell you I do it consistently and I can't tell you it's easy,

13:43 is to say to the addicts in my life

13:45 that I want to deepen the connection with them,

13:48 to say to them, I love you whether you're using or you're not.

13:51 I love you, whatever state you're in, and if you need me,

13:55 I'll come and sit with you because I love you

13:58 and I don't want you to be alone or to feel alone.

14:01 And I think the core of that message— you're not alone,

14:05 we love you— has to be at every level of how we respond to addicts,

14:09 socially, politically and individually.

14:12 For 100 years now, we've been singing war songs about addicts.

14:16 I think all along we should have been singing love songs to them,

14:20 because the opposite of addiction is not sobriety.

14:24 The opposite of addiction is connection.

14:28 Thank you.

14:30 (Applause)