Transcript for Maia Szalavitz – Unbroken Brain

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thank you for listening the human

experience is traversing the realms of

addiction and unbreaking your mind as we

welcome my guest Maya

Sullivan’s Maya it’s a pleasure welcome

to hxb thank you so much for having me

Maya you have to be one of the most

brave people I’ve I’ve read about

encountered I mean your story is quite

compelling why don’t you lay the

foundation for that for us and kind of

tell us about who you are and what

you’re doing please oh sure uh so

basically in my 20s I had a very severe

cocaine and heroin addiction I was

shooting up dozens of times a day I

ended up facing a 15 to life sentence

for selling coke and I was basically

miserable Wow

okay and and you’ve shifted that from

writing writing at least seven books and

I mean you write for Time magazine what

happened how did you go from you know

using these these substances and to

being addicted to them and to you know

where you are now

sure well just to get there we have to

go back a little bit before I became

addicted I was at Columbia College I had

been a straight-a student I was a very

driven person and that you know was sort

of from birth from the time I was really

really little I was always sort of

obsessive and that I think gave me both

the ability to succeed and the ability

to be horribly addicted when I be

came addicted and for me what the

addiction was mostly about was that I

couldn’t connect socially I was very


I was very alienated I felt unlovable

and when I found drugs it was sort of

the first obsession that I was going on

and on about that other people actually

wanted to listen to and so that made me

very favorable towards drugs also when I

got to college I was sort of terrified

of the whole new social scene that I had

to once again deal with I had finally

made a few friends in high school

and so then College I’m thrown into this

whole thing and I was just terrified and

I discovered very rapidly that if I had

cocaine people wanted me around and I

didn’t need to worry about oh they hate

me they think I shouldn’t be here

because when you were bringing the coke

people are very happy to see you yeah I

mean that that sounds like quite the

situation I mean there’s there are

certain hallmarks of addiction and kind

of pattern recognitions where you can I

mean there’s there’s genetic traits and

personality disorders I mean what did

you what did you discover as while you

were writing this book as some of the

misconceptions that we have regarding

addiction a lot of people think that

there’s a single addictive personality

and that is one of the biggest myths

about addiction that’s this idea that if

you have sort of one kind of addictive

obsession you won’t be able to control

your use of any other substances and if

you’re addicted to gambling you’ll also

be addicted to food and sex and drugs

and all different types of drugs and

alcohol while it’s certainly the case

that addictions do tend to run together

it’s not the case that everybody with

addiction is susceptible to all

addictions the other myth about the

addictive personality is that all people

with addiction are liars are

compulsively antisocial are you know

just basically nasty horrible people and

in fact

the things that predispose people to

addiction can range incredibly widely so

if you’re a really anxious and nervous

person who is oversensitive and who

really is quite a caring person you

might be very high-risk but you also if

you’re on the other extreme of that if

you’re really bold and actually somewhat

callous you’re also at higher risk and

most people don’t have both of those

characteristics at least not at the same

time so and certainly not most people

with addiction so addiction is sort of

you know there’s there’s a sort of joke

addicts are like everybody else only

more so and that kind of captures the

fact that it is extremes that predispose

you but some of these extremes are

opposite to each other and the idea that

all people with addiction are compulsive

liars or are dishonest or are

fundamentally bad people is just false

are you saying that it’s not solely

based on physiology and it can be based

on other things well and this depends on

if you want to get into the mind-body

problem but the my point is really that

addiction is a complex multifactorial

thing and so genes do play into it

absolutely but so does the environment

and the environment plays into it in an

incredibly complex way over the course

of development so that things that

happen very early on can have an

outsized effect and even the way you

interpret your experience is important

in addiction because for example you

can’t be addicted to something if you

don’t know that the drug causes the

effect that you like hmmm let’s let’s

explore that further what do you mean by

that so like there are people who will

go into the hospital they will have

surgery they will be on opioids long

enough to develop physical dependence on

the drug and then they go home and they

basically go into withdrawal but since

they have no idea that they have

developed physical dependence on the

drug they don’t have any craving for it

since they don’t know what to crave and

they are actually in that instance they

are not a

they are simply physically independent

but in order to be addicted you have to

know that it’s the drug that solves your

problem interesting so it’s it’s more of

a mental psychological thing yeah

absolutely and when people talk about

you know the horrors of opioid

withdrawal the physical stuff really

isn’t that bad anybody who has had any

serious medical problem as well as an

opioid withdrawal experience can tell

you that most serious medical problems

are most are way worse I once had

hepatitis A and that was definitely way

worse than withdrawals but the the point

is that what really is horrible and

causes suffering and withdrawal is not

that physical things not the puking and

the sweating and the shaking I mean

those aren’t fun but it’s the mental

agony it’s the sense that you will never

ever have a sense of safety or comfort

or pleasure again and it’s like breaking

up with you know the love of your life

and that’s where the pain comes in um I

personally kicked heroin about six or

seven times it was I never relapse

during the withdrawal part when I was

sick and feeling lousy I always relapse

like a couple of weeks or months later

when I was like oh I’m fine I can do

this on weekends hmm interesting I mean

how do you how do you feel about the

role of policy and where legislation is

in regards to addiction and like how how

our society and the stigma of being

addicted being an addict I mean it’s

it’s absolutely ridiculous the way we

deal with this there is no science

whatsoever to our drug laws there is no

rational way you could make a case to

have marijuana illegal and tobacco legal

that is just not anything that can

actually be based on anything other than

racism and colonialism which is what it

is actually based on until we recognize

this we’re going to be struggling with

these really lousy absurd drug laws if

we want to say addiction is a medical

problem which I believe it is it is

absolutely absurd to think that

criminalization is going to help

and in fact addiction is actually

defined by the DSM psychiatry’s

diagnostic manual as compulsive behavior

despite negative consequences negative

consequences is another word for


so therefore if punishment were to fix

addiction addiction wouldn’t actually

exist so we’re really dumb in terms of

our drug policy yeah agreed

I mean it feels like the war on drugs

has been an abject failure if you look

at it from the stance of helping people

if you look at it from the stance of

enslaving the humanity well yeah the war

on drugs is a gleaming success yes I

mean it’s it’s a success at racism and

it’s a success at creating mass

incarceration and I suppose there’s some

employment involved with that like it is

absolutely not a success at controlling

demand at controlling supply or it

dealing with drug related harms in fact

it tends to make them worse so so Mya

let’s let’s get them at the root of this

I mean it I mean if if you’re just a

normal person I mean if there is such a

thing but if you’re just kind of

operating on you know a regular schedule

you have a nine-to-five job and yet you

use cocaine on the weekends I mean what

what’s wrong with that picture

I don’t think there’s anything wrong

with that picture unless you are harming

yourself or others addiction is not

using on weekends generally although you

you can have certain addictive patterns

where you binge and you know spend all

your money on coke every weekend and

then can’t pay the rent but if you are

in a situation where your drug use is

not causing harm to you is not messing

up your career is not messing up your

relationships you know is basically


that’s not addiction and to my mind that

isn’t anything the state should care

about I mean what in your opinion is is

an addict looking for I mean it seems

like people who are drug seeking and

look they’re they’re searching for a way

to escape this sort of pain this turn

internal soul pain that they have do you

agree with that yeah I think that

addiction is very often a search for

escape on there is

there are so many different ways you can

get into addiction but the vast majority

of them do involve some sort of self


about two-thirds of people in addiction

and an even larger number for women have

severe childhood trauma and there’s

enormous ly high rates of sexual abuse

amongst women with addiction so you know

a lot of people are trying to

self-medicate that there are also

there’s also a really high prevalence of

mental illness pre-existing mental

illness among people with addictions so

the same genetics that predisposes you

to say depression can also predispose

you to addiction either because it makes

you more vulnerable to the drugs

themselves or because you want to feel

better so you start taking them so

you’re saying that having a mental

condition kind of amplifies your either

need your need for that that certain

drug that kind of alleviates those

symptoms yeah well I mean if you have

any type of mental illness or

personality disorder you know you’re

different from other people you’re

different from other people in different

ways depending on what your actual

problem is but the you know you know

that you stand out you don’t feel

comfortable you are not happy I mean

mental illnesses are defined by you know

causing significant impairment and

disability so who wants to feel awful

all the time um

yeah people are generally seeking ways

to you know feel okay and to connect

with other people and drugs often offer

a way into that for a lot of people I

mean one of the things I think is really

sad is that you know if you look at a

high school if you want to be in any

clique it’s hard but the drug users

pretty much accept anybody as long as

they take drugs and that’s a very

admirable thing in some sense but it is

sad that that is the group where that

acceptance is there yeah I mean we’re

probably gonna jump around in this

conversation but going back to genetics

I mean if you look at

sort of the studies on adoption and like

twin studies and twins reared apart I

mean what have you seen in your research

in regards to that as far as most of the

research on that is on alcoholism and

basically that shows that about half the

risk is accounted for by genetic factors

and it’s probably the same with other

drugs but the data is not you know

there’s just there’s not as many people

with addiction to the other drugs so

there’s not you know as much data on it

certainly not going back generations the

way there is with alcoholism but it is

absolutely the case that you know

genetic factors play into it and there’s

a huge range of genetic factors that can

have an influence for example there is a

gene that is common in Asia that makes

you quite uncomfortable when you drink

like your skin turns red and you feel

like warm and it’s not pleasant at all

and so those people with that gene are

like 10 times or some really high number

they’re really less at risk however in

Japan where that gene is quite prevalent

during the I guess 80s and 90s there was

this whole there developed this whole

really heavy drinking culture among

business people and what you saw then

was that even with the presence of this

gene the number of people with the gene

that developed alcoholism was like 3

times higher during that time period so

you know people’s choices and people’s

cultural pressures also play a big role

I mean where are you at with the whole

12-step you talk about the kind of the

concept of kind of hitting rock bottom

and I mean is that a false idea it’s a

very very very destructive myth the idea

that if you just make things bad enough

for people with addiction they’ll get

better has caused a lot of abuse a lot

of death a lot of psychological damage a

lot of making a lot of people’s lives

worse for a really long time in the name

of something that simply is not the case

if you look at when people recover

people are actually more likely to

recover if they still have a job if they

still have their family if they still

have resources I mean if you just think

about it logically who would you pick as

most likely to recover a doctor or a

homeless person yeah so true I mean have

you found that addicts move into other

forms of sort of addiction like a person

who is addicted to cocaine going into

kind of addiction towards sex yeah I

mean people can certainly do that it

just you know that happens to about half

of people with addiction they will

develop more than one but it’s you know

is it Universal no are there people who

can have addictions to say alcohol but

not marijuana absolutely are there

people who are addicted to cocaine but

not pot yes um so you know it’s not

always the case that everybody needs to

be totally abstinence forever obviously

that’s the safest route to take

but the this idea that you know you must

be perfectly abstinent from everything

if you’ve ever had an addiction to

anything just is unrealistic and also

incorrect yeah I mean um and we’re I

mean where is your research as far as

the harm reduction and the bringing I

mean what what is that we can do to kind

of help people who are struggling with

this sure so um as with helping anybody

else compassion love affection support

treating people with dignity and respect

all matter tremendously in addiction

what basically happens is that the

system that allows you to fall in love

with people or you know care for your

baby gets misdirected towards the drug

and so in order to help that system heal

relationships are critical and so what

people with addiction need they don’t

have any lack of pain what they are

missing is often hope and love and


and so tough-love is exactly the

opposite thing that they need now that’s

not to say that you should you know

tolerate an addicted family member

beating you up or stealing from you or

doing any kinds of nasty things it’s

just if you throw them out of the house

that will help you not them and it is by

the way perfectly acceptable to do that

to help you or your own family because

you can’t help anybody if you are being

abused so you know it is sometimes

necessary for people to cut people with

addiction out of their lives for that

reason um it just doesn’t work to save

their lives it may actually do the

opposite Wow

yeah you know I was reading I was

reading the story prior to this

interview about this this woman this

girl who was struggling with with heroin

usage and her parents found her needles

kicked her out of the house she ended up

becoming homeless I mean the story got

much much much worse and like what is I

mean what is your opinion about just

throwing someone into a kind of really

AB facility well it usually doesn’t work

um the thing with opioids in particular

is that the only treatment that we know

that reduces mortality and it reduces it

by 50 to 70 percent or more is

indefinite potentially lifelong

maintenance with either methadone or

buprenorphine which is better known as

suboxone so throwing somebody into an

abstinence rehab on will actually just

put them at risk of overdose that is way

more severe than when you started with

30 days after that you know a lot one of

the incredible things that has happened

in the last few years is Hazelden which

is the model for the 28-day rehab in

which you know is very strongly into 12

steps and complete abstinence from

everything they were finding that many

of their patients who had opioid

addictions unlike their alcohol patients

the opioid addiction patients would go

out and they’d be dead in a week and so

they now have decided that they will be

doing buprenorphine maintenance for some

of their patients the

because otherwise they die so it is

really important to know a that the best

treatment for opioid addiction is not

residential abstinence treatment and

it’s also important to know that

coercion is usually not the best way to


treatment in this country has suffered

an enormous amount because it basically

gets people that are forced to be there

if you are making cars and your

customers are forced to buy them you

don’t have to make very good cars if

your customers are forced to go into

treatment you can do absolutely awful

things to people which treatment

unfortunately sometimes does you know a

lot of treatment in the past and some

still to this day is based on the idea

that we will make you hit bottom we will

make you feel powerless we will attack

and humiliate and try to break your

personality into pieces you know who

would voluntarily choose that you know

the reason people with addiction avoid

treatment is not generally that they’re

having so much fun getting high it’s

that most treatment they know doesn’t

work and treats them awfully Wow

I mean it’s horrifying it seems like the

culture that we’ve established in

regards to you know the stigma behind

behind drug use and the criminalization

aspect of it is just it’s so completely

backwards it really is and what’s what’s

very odd about it is that you know the

12-step treatment providers have gone

around saying addiction is a disease but

the treatment is a self-help group that

teaches you prayer confession and

restitution and so people quite

logically react to that by saying you

don’t really think it’s a disease you

think it’s a sin and that’s not to say

that many many people don’t find help

from 12-step programs but it is to say

that they are not modern medicine hmm

interesting you know again it for the

research for this episode I was I saw

ended up seeing an a sign in Amsterdam

on the internet that said the cocaine


is being sold on the street has cut is

actually white heroin please be careful

and for tourists have died using this

and what an amazing approach you know if

we just kind of looked at this as a

health disorder rather than a criminal

disorder maybe we would make some some

progress but we absolutely would because

we’re throwing away money and people’s

lives right now

I mean why does anybody think that

putting someone in a cage is going to

fix any kind of psychological problem it

makes absolutely no sense the idea that

locking people up for possession would

be helpful for anything is ridiculous

the you know the idea of that is to make

it so stigmatized that people won’t do

the drugs but obviously that has failed

to work and it is ridiculous that we are

saying we must do we must distinguish I

as addiction but we criminalize it which

is the opposite thing like if it’s just

you know counterproductive I mean do you

find that most addicts want to get clean

and they’re just there there’s they’re

so compelled the the compulsion is so

high that I mean they just can’t well I

mean I think it’s complicated first of

all I would urge you to avoid the word

clean because that implies the people

who are still using are dirty and it’s

you know we just use this horribly

stigmatizing language though and I have

to catch myself I try to use people with

addiction as opposed to addict because

we don’t like in news coverage we don’t

say that person is a schizophrenic we

say that’s a person with schizophrenia

but we say that person is an addict so

anyway but yeah we just we do so many

things backwards and yes people with

addiction often are ambivalent about

quitting they feel you know again

imagine giving up the love of your life

imagine feeling like you know you’ve

been loved this way only this one time

and now you are giving that up like if

you heard a song that was your song or

if you you know saw like that person on

the street you would probably want to

talk to them you know it’s not

surprising that it is hard to

get over addiction but what I think I

think love is the best comparison to it

and yes like breaking up totally sucks

and some people actually do suffer

physical withdrawal in breaking up with

people you know it you know the

basically in the brain love is the

template that gets captured by addiction

but the good thing about that and the

thing that I think is important to

stress is that falling in love isn’t

breaking your brain falling in love is a

deep emotional form of learning that is

very hard to undo as anybody who’s ever

been dumped can tell you but the you

know but it’s not impossible and it’s

not brain damage it is simply a state of

maladaptive learning interesting I mean

is there a point and this is I mean this

is just kind of a rhetorical and for the

audience question is there a point where

you think it’s too late to help someone

no um I think that there may well be

people whose lives are so traumatic and

so compromised by a mental illness that

they may not be able to maintain

abstinence but there’s lots of things

you can do to help people in that state

first of all you can help them have a


second of all you can help them have

access to drugs that are safe and not

you know impure you can be kind to them

you know there are there are many many

different ways of dealing with people

but we just have to get rid of this idea

that the only acceptable State for a

human being with a with addiction is

like hat being absolutely drug free all

the time now that can and absolutely

does happen for some people but it is

just you know we we just have this idea

I mean it’s almost it’s like a form of

prejudice that if you have this

substance in your blood you are a bad

person yeah I mean you’ve you’ve done

some work on suicide as well

what’s your what’s your stance on that

well I mean what I

I think what you’re referring to I did

some articles about overdose and suicide

and one of the things that I think we

really really need better data on is

that we really don’t know on what

percentage of overdoses are actually

suicides or are these kind of weird like

the person doesn’t care if they live or

die and I think it’s really important to

know that because when we want to

prevent overdose we want to tell people

hey don’t mix alcohol with like heroin

and benzodiazepines because that’s a

really deadly combination but if

somebody doesn’t care they made or if

they’re actively suicidal they may be

like okay good there’s the recipe so

this doesn’t mean we don’t provide that

information but it also means that we

need to find out like you know how much

of this is despair and we need to try to

address that kind of despair man it

seems like 2016 has been a year of

celebrity deaths and a lot of these

celebrities are dying from overdoses

we’re finding out you know through tox

up toxicology reports we’re finding out

that they you know prince was on

fentanyl and you know others it what’s

your what’s your stance on this how I

mean how do you think these these a list

type people are being affected by

addiction well I mean I think that if

you look at addiction rates there are

clearly occupations that are especially

high risk and celebrities tend to be

really high risk as well as really

really poor people so what do those have

in common one of the things that they

have in common is that they have sort of

structure less time a lot of the time

but the other and I think more important

thing is that like when you have

everything that you want it can become

as meaningless as having nothing that

you want and so you know I also think

that celebrities are at high risk

because the drive and the compulsiveness

and the obsessiveness and the

persistence that allows you to get

through all the rejection and all the

hard work and all the stuff that you

have to deal with to get there is

exactly the kind of thing that people

do in terms of addiction and what is

what is your research show on using

iboga to treat heroin addiction you ask

things like that I mean I think that

clearly some people find those things

helpful I think that ibogaine there is

there have been some deaths associated

with it and it’s certainly the case that

a one-shot treatment is rarely going to

fix something as complex and long-lived

as addiction howard lotsof who

discovered that ibogaine relieves opioid

withdrawal told me this story once that

I’ve never forgotten and he said that

you know he gave it to a couple of his

friends who were also heroin addicts and

you know he got up and he was like wow

I’m not in withdrawal I don’t have to

get high I’m free yay and the others was

like we’re like wow I’m not a myth draw

let me go score so you know it’s like

you really have to understand you know

if people don’t have anything else in

their lives or if people’s like identity

is really wrapped up in you know being

an active drug user um you know unless

you come up with things that are going

to deal with that you know simply with

relieving the withdrawal or simply

having the insight that wow this is like

a huge problem for me which a lot of

people can get during the psychedelic

experiences and they can get insight

into trauma and all kinds of other

things but that insight alone is often

not enough if you don’t have support if

you don’t have you know something else

to live for it can be really really

difficult so I think you know again we

want to have as many tools as we

possibly can have to help people recover

and I think we definitely need more

research on all of that kind of stuff

but I think it’s equally dangerous to

call those things cures and to make to

over-promised because that’s the history

of addiction treatment it’s like people

are go around proclaiming this is a cure

and very quickly they find out that it

isn’t yeah that’s a safe perspective

I mean my what what is the single you

know first thing that perhaps someone

that is listening to our voices right

now can do that is struggling from for

from addiction and wants to not suffer

anymore um I always suggest that people

start with a complete psychiatric

evaluation by somebody who is not

affiliated with any rehab or any

addiction program at all

because so many people with addiction

have trauma and have other psychiatric

disorders it’s really good to know

what’s going on from the start so that

you can find the kind of help that’s

best for you so that I certainly

recommend I definitely also recommend if

you have an opioid addiction the safest

treatment options are methadone and

buprenorphine and don’t worry about oh

oh I’m replacing one addiction with

another that is absolutely not the case

because when you use methadone or

buprenorphine in an appropriate way when

you take it in a steady regular dose you

are not high you are not impaired you

can drive you can love your partner you

can take care of your kids you can do

everything that anybody else can do and

so you are not addicted you may still be

physically dependent but you know I’m

physically dependent on Prozac because

if I stopped taking Prozac I will

probably get depressed again does that

mean I’m addicted to Prozac no so I

think it’s really important to look at

maintenance medications in that light

and to not fall for the stigma that we

have associated with them I think we

really need to fight that I also think

that you know people with addiction

should read other stories of addiction

talk to other people with addiction

realize that there are many many

different paths and that if one doesn’t

work for you you can try another one

realize that even though you can’t feel

it right now there are almost certainly

people in your life that totally love

you and really care about you and are

not trying to control you or take away

your fun but they can

from their outside perspective that what

you’re doing isn’t working so those are

I think some of the key bits of advice I

would give is there a point that you

find with people who are suffering from

this disease that they are just kind of

Numb to everything well yeah that’s what

you want um you know um I think you know

when people are in that state that

they’re trying to achieve they’re really

tuned out from the world but you know if

you could stay like that it wouldn’t be

addiction it would be Nirvana right but

you can’t and you don’t and that doesn’t

work on this world so what you have to

do if somebody does seem really tuned

out is approach them at a different time

mm-hmm interesting I mean my I really

appreciate you know everything what

you’re doing you know dese – dese TIG

mitai zing this is I think so huge and

so important and really discussing this

as much as possible I think is is

crucial your story is is huge and I mean

I congratulations for you know kind of

beating this and and coming forward and

talking about it

thanks yeah no I mean it’s been really

an amazing journey and you know I it’s

funny because I you know get asked to

give advice at journalism schools and

stuff like this and I don’t want to say

well go shoot up for a few years you

know that would be a bad plan and I

certainly don’t recommend that but

because of having had the experience

that I have had unfortunate to that

experience maybe I have been able to

give a lot that I wouldn’t have

otherwise been able to do and I have

been able to understand situations that

I might not have otherwise been able to

do so so you know I guess you can make

lemonade right yeah so Maya where can

people find your work where can people

kind of get to your website give us that

oh sure so I am at just Maya a Z so it’s

ma I a s like Sam Z like zebra comm you

I also have a bi-monthly column at vice

and I write for a bunch of different

places and the book can be found it

you know Barnes and Noble Amazon

hopefully independent bookstores and


so those are a few ways thank you so

much Maya this is the human experience

we will see you guys next week


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