…and how modern society fails to meet them.
Hi everyone. I hope your summer is going smoothly, safe from insects, droughts, forest fires, and other human-assisted calamities. I’m on vacation in France now, after a harrowing trip giving talks, first in Victoria, Canada, and then in Melbourne and Brisbane. Harrowing because I flew across 16 time zones, then back, in just a week. But it was a great trip, the highlight of which was hanging out with inmates, then giving a talk, at a beautiful prison on Vancouver Island. I know the phrase “beautiful prison” is rare, but this was a rare place. It included an area for First 
Nations rituals (complete with sweat lodge!), a Buddhist meditation parkette, and wild deer running everywhere. The only problem for the prisoners was that they couldn’t leave. The place was a living contradiction, and of course most inmates had been through addiction. A few of them gave me lovely gifts when I left. They spent their time developing craftsmanship in wood and metal. (And yes, I was allowed to leave — but I felt a familiar anxiety at the exit post, left over from years ago.)
Now that the zillions of comments on April’s moving post have finally died down, here’s a “vacation post” — a shortened and revised version of an article I published in The Guardian about a month ago. I’ve been asked many times what I think about the opioid/overdose epidemic hitting the US and Canada in particular but also the UK and other regions. Here are my thoughts.
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Most drug-related deaths result from the use of opioids, the molecules that are marketed as painkillers by pharmaceutical companies and heroin by drug lords. Opioids comprise a large family of molecular cousins, some weak, some powerful, all united by their capacity to bond with the opioid receptors all over our bodies, particularly our brains. Those receptors evolved to protect us from panic, anxiety, and pain. But the gentle impact of natural opioids, produced by our own bodies, resembles a summer breeze compared to the hurricane of physiological disruption caused by drugs — opiates — designed to mimic their function. And as if heroin wasn’t enough of a bull in the China shop, most street opiates (including heroin) are now laced or replaced with 
fentanyl and its analogues, far more powerful than heroin and so cheap that drug-dealing profits are skyrocketing at about the same rate as overdose deaths. People don’t know what they’re getting and they take too much. Fentanyl is recognized as a primary driver of the overdose epidemic.
Society’s response has been understandably desperate but generally wrong-headed. We start by blaming addicts for their self-indulgence or weakness of will. We blame the pharmaceutical companies for 
developing and marketing painkillers. We blame doctors, for overprescribing opiates, which pressures them to underprescribe them, which drives patients to street drugs — cheaper, home-delivery via the 
internet, and zero quality control. We say we’re going to rekindle the war on drugs, recognized by experts as a colossal failure from the thirties onward. Dealers will always find their way to consumers if the price is right. We also continue to view addiction as a chronic brain disease, so the benefits of education, social support, and psychological intervention receive far too little attention. Black-and-white solutions are simply inadequate for a problem of such complexity.
There has been some progress: There are pockets of activity here and there where prescribed opiates — like methadone and buprenorphine (Suboxone) — are made more easily available to addicts. That’s a good thing, because increasing addicts’ desperation (e.g., methadone clinic line-ups on the far side of town) often drives 
them to the street, where they’re most likely to die. The availability of naloxone, an opiate neutralizer, is slowly wending its way through the drug policy jungle, providing a simple resource to combat overdose on the spot. But in most segments of most communities in the US and elsewhere, naloxone is still too difficult to obtain.
I think there are smarter answers at hand — but also smarter questions to be asked. The opioid overdose epidemic compels us to face one of the darkest corners of modern human experience head on, to stop wasting time blaming the players and start looking directly at the source of the problem. What does it feel like to be a human trying to make it in the early 21st century? Why are we so stressed out that our own (internal) supply of opioids isn’t enough to feel okay?
The overdose crisis obviously builds on people’s desire for opioids. But what do opioids actually do? The opioid system was designed by evolution to allow us to function, not panic or shut down, when we are under threat or in pain. Critically, support from other humans also helps us cope with stress, and that support is underpinned by 
opioids too. Our attachment to others, whether in friendship, family, or romance, requires opioid metabolism so that we can feel the love. Opioids grant us a sense of warmth and safety when we connect with each other. You get opioids (from your own brain stem) when you get a hug. Breast milk is rich with opioids. Rodents play more when given mild doses of opioids.
In short, we need opioids to feel safe and to connect with each other. Then what does it say about our life-style if our natural supply isn’t sufficient? It says we are stressed and isolated. That’s a problem we need to resolve.
To confront the problem of addiction, many have proposed targeted education, community support, and interpersonal bonding through group activities. Johann Hari’s powerful book, Chasing the Scream, reviews how such initiatives have worked in diverse societies. An intriguing example is the compassionate, blame-free dialogue that has naturally evolved among high-school students in Portugal, highlighting the dangers of hard drugs and urging the most vulnerable to abstain — not because they’re going to get in trouble but because addiction is miserable and dangerous! The emergence of this dialogue has been particularly meaningful because it has paralleled the decriminalization of drug use. Portugal had an astoundingly high heroin addiction rate 17 years ago. It now boasts the second lowest overdose rate on the continent. Drug addiction has diminished significantly in Portugal because compassion and social inclusion actually work against addiction, while punishment only fuels it.
But let’s look beyond the challenge of addiction per se. The peculiar appeal of opioids tells us more about ourselves as a society, as a culture, than addiction statistics can reveal. Today’s young people come of age and carve out their adult lives in an environment of astronomical uncertainty. Corporations that used to pride themselves on fairness to their employees now strive only for profit. The echelons of management are as risk-infected as those of the lowest clerks. Massive layoffs rationalized by the eddies of globalization make long-term 
contracts antique. I ask the guys who come to the house to deliver packages or upgrade our TV box how they like their jobs. They can’t say. They get up to three six-month contracts in a row and then they get laid off so the company won’t have to pay them benefits. People pour out of colleges and universities with all manner of degrees, yet with skills that are rapidly becoming irrelevant. But people without those degrees are 
even worse off. They find themselves virtually unemployable, because there are so many others in the same pool, and employers will hire whoever comes cheapest. (The absurdly low minimum wage figures in the US clearly exacerbate the situation.) As hope for steady employment fizzles, so does the opportunity to connect with family, friends, and society more broadly, and there is way too much time to kill. Opioids help reduce the despair.
The opportunity to settle into a viable niche in one’s family and one’s society, the bedrock of social and personal security, is being blown away by the winds of unregulated capitalism in a globalized world. As for the intimacy and trust we humans have always sought in each other, in friends, colleagues, and lovers, the bonds are shaky these days. Even if we have the opportunity to connect — if we are not resettling geographically to find employment or staying up late to retool through distance education or simply sitting on the sofa all day long collecting welfare — we’re still too stressed and depressed to get to know each other, to develop trust, to give and receive compassion.
(The links between under-employment, family dissolution, and addiction are beautifully reviewed by Sally Satel. And many of you may know of Bruce Alexander’s explanation of how globalization feeds addiction.)
The early 21st century offers less structure and stability through religion, and through extended family relationships, than we have experienced in thousands of years. And maybe that’s just the way it is. But we don’t have to throw away the basic currency of security and interconnectedness entirely. We can build social structures — governments, corporations, community organizations, and systems of education and care — that encourage stability, hope, and trust in our day-to-day lives. Like the high-school kids in Portugal, we can offer compassion and inclusion as an alternative to heroin. If we fail to do that, many of us will want to hook ourselves up to an opioid pump. Just to endure.
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I’m not entirely pessimistic, but that’s the way I see it. Regardless, let’s not give up hope, not even slightly. Let’s do a bit of meditation, enjoy the sunshine, and be good to each other. See you again in September.
Informed by unparalleled neuroscientific insight and written with his usual flare, Marc Lewis’s The Biology of Desire effectively refutes the medical view of addiction as a brain disease. A bracing and informative corrective to the muddle that now characterizes public and professional discourse on this topic.” —Gabor Maté, M.D., author of In The Realm of Hungry Ghosts: Close Encounters With Addiction
I read that book “Chasing the Scream” and it really opened my eyes about just how unbelievably damaging the “war on drugs” has been. I never cried so much reading a book! Anslinger was a horrible man when you really think about it. But I think Portugal has the right idea. The illegality of drugs are part of the lure. If all were decriminalized and maybe eventually made legal, the number of users would drop significantly, I’m sure.
Marc, good to know there’s at least one prison on the planet built for … human BEING(s). What’s it called?
It’s called William Head Institution, and here’s a link: http://calgaryherald.com/infographic-a-look-inside-b-c-s-club-fed-prison
It was indeed an optimistic look at how prisons COULD operate, but hard to reconcile with the paternalistic parole system that still governs these guys’ lives.
Definitely agree!!! But why do you use those horribly stigmatizing pictures of people with addiction, which have been shown to decrease exactly the kind of empathy we need to support recovery and have solidarity in the face of unfettered capitalism?
Maya do you think we should be showing pictures of people happily shooting heroin saying life is just wonderful? I don’t think that is realistic either….
How about not showing any pictures? That way nobody gets riled.
I agree. The nastiness, misery, and mind-numbing boredom are facets of addiction. For some, not all. I don’t want to hide these features, but I don’t want to blame the victim either.
I meant I agree with Will. Maia, don’t worry. We don’t have to walk on eggshells if our message is clear and consistent!
Hi Marc:
Beautiful and thoughtful piece. Plan to share it with others who work in the field and some others who work in the prisons as well.
Totally agree that we need to build community and that is the best approach to the crisis but also the other ills. Have recently begun reading Zen and the Art of the Motorcycle Maintenance and love the idea of Chattaquas where the community comes together to celebrate together and talk and think about important issues. Shared this with an older friend and she told me that she read one of her grandparent’s diaries and found an entry where she spoke fondly about looking forward to upcoming Chattaquas – and this was in Depression era rural Saskatchewan. The thing is we can do these things. Instead of being social on social media we can bring together the community to talk and learn and share in events that are not about making money or promotions but just connection and celebration and discussion. I plan to try to organize such events in my community in Newmarket. Think it would be great to have Chattaquas on issues like addiction so we could come together as a community and listen to and hear all sides of the discussion. Keep up the great work and hope to see you in the GTA in October.
Tim Greenwood
Great idea, Tim. In fact we can do both: arrange Chautauquas and present our case in the media. More soon.
Are you from NewMarket, TN? Wondered. I’m visiting family. I live in SW Florida. My visit only made possible by my brother and wife. I’m broke, pretty much unemployable due to felonies fro 7 years ago. Posession, resisting arrest. All due to drug addiction. I was a RN. Now, get denied for minimum wage jobs.
You fail to mention one of my ” favorites” the depersonalizing” effects and impact of the internet and supporting technologies such as texting, Twitter etc etc
Absolutely! Technology taking the place of families and friends talking face to face.Its easier to text, FB , etc.
Hi Marc
Yet another really good piece that captures some very complex issues. I’ve been talking about this and writing bits about it for the past few months. In the UK you can roughly break it down to two very different issues. One involvese people who have been in drug treatment for many years, often well over twenty, who haven’t made healthy life choices. They probably started using dependently in the late 80s/early nineties, were prescribed methadone but carried on using, maybe to a lesser degree, drinking hazardously, smoking and using other drugs like benzodiazepines. Now, in their late 40s or early 50s they are suffering from chronic seriously debilitating conditions like COPD, liver disease, diabetes and cardio vascular diseases usually associated with people in their 70s. Unfortunately there are lots of them and they’re dying in droves. Personally I’ve long ago lost count of the friends I’ve lost in this way. Politicians and public health bods have even come up with a descriptive phrase for them, “the train spotting generation”, after the film and book by Irving Welsh.
The second, in the main are people who, for whatever reason, aren’t in treatment and therefore at almost daily risk of overdose. Throw fentanyl, or it’s anologues, in the mix and you’ve got people playing a daily game of Russian roulette with four or five bullets in the gun. A friend of mine, who researches these things, has a private inkling that a lot of these accidental overdoses are probably suicides, which throws yet another layer of complexity into an already very complex mix. Unfortunately, rather than responding to this by making treatment easily accessible, attractive and meaningful, the providers, commissioners and politicians seem intent on making it more and more difficult. I’ve always seen someone looking for help as being in a massive window of opportunity for, given the right set of circumstances, profound and lasting change to occur. This means that the service they go to should have a wide window of tolerance that enables them to walk through with a minimum of fuss. They should be met with flexibility, adaptability, cohesiveness, energy and stability, anything less makes the dealer seem more attractive and easier to access. Unfortunately it’s nothing like this and people are met with, more often than not, exactly the opposite so they don’t bother and instead they consult doctor fentanyl.
Peter! I havent been able to email you. New address? Trying to contact you. Please provide.
Hi Marc
Yeah my newish account is petersheath@outlook.com thought it was a bit strange not getting a reply.
Hey Peter!
It’s good to hear you (this blog is like a meeting of sorts– a very special meeting!)
I talk about “the window of opportunity” you mention when I speak to clinicians, programs, detoxes and the like. It does not stay open indefinitely. People do not sit around for days or weeks or months in a waiting room looking at their watch and “Bonanza” reruns. They go back out. And the best time to pull people through that window is while they’re in detox, because that is where most make the decision to quit. They are in shock, beaten down, vulnerable and desperate for a way out. Their situation is right in front of them, stark and salient. If someone doesn’t reach them at that point with a plausible opportunity to free themselves from the habit, their only option is stark and salient as well.
From my own experience and talking to addicts, I’ve drawn a similar conclusion as your friend. But when police and emergency services start making noise about not responding to ODs because of the toxicity of the poison carfentanyl– rumored or not– we’re coming to a breaking point. Public outcry and misbehavior are born of rumor.
Hi Matt
Spot on but, unfortunately, not very well recognised by many. “I’ll make you an appointment in two weeks time” or “you’ll have to join this group or go to that programme to demonstrate your motivation and/or willingness.” Ain’t going to wash when I rock up in my brief and ever diminishing window of opportunity. I want help and I probably need it right now, I may be dead tomorrow while your waiting for my motivation to become even more evident than it does now!
We work in a target driven environment underfunded, understaffed, undervalued.
The Goverment in the UK has cut budgets even further, delivered what I think is a poor cop out of a drug Strategy.
People are dying I agree with comments above an aging drug using population with poor health. Poor quality substances that now have been laced with an extremely potient killer to line the drug dealers pockets. No housing ,no prospects,no respect a benefit system thats killing people.
The place is a mess
People having to jump through hoops to gain OST treatment
I am passionate substances misuse practitioner and agree you need to strike while the irons hot.
I have a great number of successful outcomes driven by the client. I am but a guide helping the client to find the tools to live again.
I work in Treatment in Bradford.
Yorkshire and the Humberside at the moment has a huge overdose rate.
Thanks for this update, John. The UK really does sound like a mess — pretty much neck and neck with the US. Maybe the overdose epidemic can have some kind of silver lining by waking people up to these deeply embedded problems.
Marc in Bradford UK where I work we give out naloxone kits which I have been told it has been very successful in saving lives in our region.
They are given out in the Needle exchange. If identified in assessment that a client is at risk from overdose or is in contact with a peer group that are high in risk taking. They will be immediately give a kit. All the hostels and other social care providers are give training and kits.
So as you can gather most of our clients have naloxone kits.
That’s really good to hear, John. The same enlightened policy is creeping in all over the place. It was spear-headed in Canada by the Insite (supervised injection) site in Vancouver. Here’s the link: http://www.vch.ca/Locations-Services/result?res_id=964
Keep up the good work!
Marc I am interested in the group in the UK you mention below. Addiction Theory network.
Could you please send me more infomation
With kind regards
John Fox
Matt and Peter. You guys see the underlying schisms so well, and express them so clearly. Thanks for piping up — again.
Peter, speaking of the importance of rapid and flexible response, I’d be very curious as to what’s happening with the “Birmingham Model” that we’ve reviewed here on this blog — https://www.memoirsofanaddictedbrain.com/connect/birmingham-model-the-view-from-the-ground/ — and which I also describe in the last chapter of my last book. Would you be willing to give us an update — hopefully as a guest post, not a comment? Let me know.
Hi again, Peter. Finally home and have a chance to catch up. Thank you for breaking the problem down into these two component problems. It’s tremendously helpful, because these are radically different populations — different ages, different stages of addiction, different relationship to the social order, etc.– and so the solutions for their alienation and stress will also have to be different.
I also very much like a theme that I think is recurrent in your work: the idea that timely, creative, compassionate addiction treatment can be a portal to change, not just a bandaid to partially staunch the bleeding. This is a powerful idea. If we see addiction as a an expressive act (“cry for help” isn’t far off) rather than a form of suicide, much good can come of it.
Hi Marc,
PHS now has housing and recovery programs in Victoria. If I’d known I would
Have tried to meet for a dinner as I move back and forth between. An liver and. Ictoria almost weekly.
All the best,
Russ Maynard
PHS
Hi Russ. I should have contacted you. But the timing didnt allow much leeway. More later. Im tapping this on my phone.
Marc, thank you for this.
I share the perspective expressed here and in Alexander’s work: “The project is to reshape society with enough force and imagination to enable people to find social integration and meaning in everyday life.”
I have needed to be quite creative and persistent myself in reshaping the world inside and around me. Building and growing community, getting outside my comfort zone and sometimes (often) that of others.
Like you, I enjoy asking pointed questions, being direct.
One friend calls me a “fearless hugger” because he’s seen me approach and hug complete strangers (and some stranger than others:) Some even stranger than me.
How else does anything change unless we insistently disrupt it? We can each do our little part and then tell about it.
Hi Joanna, Thanks for highlighting the link with Bruce Alexander’s work. I’m going to insert a link in your comment to complement the one I already included in the post.
You and others should be aware of a newly formed group, the Addiction Theory Network, which started up in the UK and has members from all over the world. They (we) are pretty much unanimous in “saying no” to the brain disease model of addiction….but the group is also very active, disruptive, energetic, etc, implementing the creative protest that you remind us is so important.
Hi Marc, I’m very interested in the addiction theory network – but I can’t find information on it. Do you have any links?
Nicely written article. Thanks for sharing this. Drug addiction may be a blamed to all the players, from the drug companies, the government, the people. I must agree that it still boils down to the person if he or she will go to the path of drug addiction. If the feeling of being stressed and isolated is the problem, then it needs to be resolve. Focusing on the human growth and development in terms of psychological and emotional can be important, for example, personal development programs and the like. We can be internally resilient and strong, and we should not rely on taking harmful substances, for this case the use of opioids.
What are we doing? What are we learning?
I share your line of thinking expressed here.
I have needed to be quite creative and persistent myself in reshaping the world inside and around me. Building and growing community, getting outside of my comfort zone.I work in Treatment of drug addicts
It’s not me who’s addicted. It’s my Fast-Spiking Interneurons!
Interesting research … https://today.duke.edu/2017/09/one-powerful-cell-makes-or-breaks-your-habits
Thank you for this article. Addiction is definitely an overwhelming epidemic in the USA Today. It is a problem that needs to be addressed. I am now clean and sober, after many attempts at various types of rehabs and sober livings. I needed something different in order to get clean and sober.