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Gross.\u003c/p>\n\u003cp>Szalavitz is the author of \u003cem>Unbroken Brain\u003c/em>, a book that challenges traditional notions of addiction and treatment. Her work is based on research and experience; she was addicted to cocaine and heroin from the age of 17 until she was 23.\u003c/p>\n\u003cp>Szalavitz is a proponent of \"harm reduction\" programs that take a nonpunitive approach to helping addicts and \"treat people with addiction like human beings.\" In her own case, she says that getting \"some kind of hope that I could change\" enabled her to get the help she needed.\u003c/p>\n\u003chr>\n\u003ch3>Interview Highlights\u003c/h3>\n\u003cp>\u003cstrong>On the limitations of \u003ca href=\"http://www.npr.org/tags/381641163/12-step-program\" target=\"_blank\">12-step\u003c/a> programs\u003c/strong>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The data shows that \u003ca href=\"http://www.npr.org/tags/276505286/cognitive-behavioral-therapy\" target=\"_blank\">cognitive behavioral therapy\u003c/a> and motivational enhancement therapy are equally effective, and they have none of the issues around surrendering to a higher power, or prayer or confession.\u003c/p>\n\u003cp>I think that one of the problems with the primary 12-step approach that we've seen in addiction treatment is that because the 12 steps involve moral issues, it makes people think that addiction is a sin and not a disease. The only treatment in medicine that involves prayer, restitution and confession is for addiction. That fact makes people think that addiction is a sin, not a medical problem. I think that if we want to destigmatize addiction, we need to get the 12 steps out of professional treatment and put them where they belong — as self-help. ...\u003c/p>\n\u003cp>That doesn't mean that professional treatment can't refer people to AA as a support group, but professional treatment should consist of things that you cannot get for free elsewhere.\u003c/p>\n\u003cp>\u003cstrong>On the efficacy of maintenance treatment\u003c/strong>\u003c/p>\n\u003cp>Buprenorphine and \u003ca href=\"http://www.npr.org/tags/477525967/methadone\" target=\"_blank\">methadone\u003c/a> are the two most effective treatments that we have for opioid addiction, and that is when they are taken indefinitely and possibly for a lifetime. So these medications are opioids themselves. They each have slightly different properties ... but what they do is they allow you to function completely normally. You can drive. You can love. You can work. You can do everything that anybody else does. ...\u003c/p>\n\u003cp>The way they are able to do that is because if you take an opioid in a regular steady dose every day at the same time and the dose is adjusted right for you, you will not experience any intoxication. The way people with addiction experience intoxication is that they take more and more and more, they take it irregularly, the dosing pattern is completely different. But if you do take it in a steady-state way — which is what happens when you are given it at a clinic every day at the same time — you then have a tolerance to opioids which will protect you if you relapse, and will mean that the death rate from overdose in people who are in maintenance is 50 to 70 percent lower than the death rate for people who are using other methods of treatment, and that includes all of the abstinence treatments.\u003c/p>\n\u003cp>So maintenance is a really important treatment option for people with opioid addiction. It should be the standard of care. No one should ever be denied access to it. Unfortunately, we have this idea that if you take methadone or buprenorphine, you are just substituting one addiction for another.\u003c/p>\n\u003cp>\u003cstrong>On not serving any time in prison after being caught with 2.5 kilos of cocaine when she was 20 years old\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>I have to say that being white and being female and being a person who was at an Ivy League school and being privileged in many other ways had an enormous amount to do with ... why I was not incarcerated and why I'm not in prison now. I think our laws are completely and utterly racist. They were founded in racism, and they are enforced in a thoroughly biased manner. I was extraordinarily lucky to have an attorney and a judge that saw that I was getting better, and that allowed me to avoid that.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 Fresh Air. To see more, or listen to the whole show, visit \u003ca href=\"http://www.npr.org/programs/fresh-air/\" target=\"_blank\">Fresh Air\u003c/a>.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=%27Unbroken+Brain%27+Explains+Why+%27Tough%27+Treatment+Doesn%27t+Help+Drug+Addicts&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n","blocks":[],"excerpt":"\"We have this idea that if we are just cruel enough and mean enough ... to people with addiction, that they will suddenly wake up and stop, and that is not the case,\" journalist Maia Szalavitz says.","status":"publish","parent":0,"modified":1467991673,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":16,"wordCount":742},"headData":{"title":"Why 'Tough' Treatment Doesn't Help Drug Addicts | KQED","description":""We have this idea that if we are just cruel enough and mean enough ... to people with addiction, that they will suddenly wake up and stop, and that is not the case," journalist Maia Szalavitz says.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"209896 http://ww2.kqed.org/stateofhealth/?p=209896","disqusUrl":"https://ww2.kqed.org/stateofhealth/2016/07/07/why-tough-treatment-doesnt-help-drug-addicts/","disqusTitle":"Why 'Tough' Treatment Doesn't Help Drug Addicts","nprImageCredit":"Taylor Callery","nprByline":"\u003cbr />\u003ca href=\"http://www.npr.org/sections/health-shots/2016/07/07/485087604/unbroken-brain-explains-why-tough-treatment-doesnt-help-drug-addicts\">Fresh Air\u003c/a>","nprImageAgency":"Ikon Images/Getty Images","nprStoryId":"485087604","nprApiLink":"http://api.npr.org/query?id=485087604&apiKey=MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004","nprHtmlLink":"http://www.npr.org/sections/health-shots/2016/07/07/485087604/unbroken-brain-explains-why-tough-treatment-doesnt-help-drug-addicts?ft=nprml&f=485087604","nprRetrievedStory":"1","nprPubDate":"Thu, 07 Jul 2016 16:17:00 -0400","nprStoryDate":"Thu, 07 Jul 2016 14:21:00 -0400","nprLastModifiedDate":"Thu, 07 Jul 2016 15:13:35 -0400","nprAudio":"http://pd.npr.org/anon.npr-mp3/npr/fa/2016/07/20160707_fa_01.mp3?orgId=427869011&topicId=1128&d=2182&p=13&story=485087604&t=progseg&e=485104222&seg=1&ft=nprml&f=485087604","nprAudioM3u":"http://api.npr.org/m3u/1485139645-789453.m3u?orgId=427869011&topicId=1128&d=2182&p=13&story=485087604&t=progseg&e=485104222&seg=1&ft=nprml&f=485087604","path":"/stateofhealth/209896/why-tough-treatment-doesnt-help-drug-addicts","audioUrl":"http://pd.npr.org/anon.npr-mp3/npr/fa/2016/07/20160707_fa_01.mp3?orgId=427869011&topicId=1128&d=2182&p=13&story=485087604&t=progseg&e=485104222&seg=1&ft=nprml&f=485087604","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Tough love, interventions and \u003ca href=\"http://www.npr.org/tags/381641163/12-step-program\" target=\"_blank\">12-step programs\u003c/a> are some of the most common methods of treating drug addiction, but journalist Maia Szalavitz says they're often counterproductive.\u003c/p>\n\u003cp>\"We have this idea that if we are just cruel enough and mean enough and tough enough to people with addiction, that they will suddenly wake up and stop, and that is not the case,\" she tells \u003cem>Fresh Air\u003c/em>'s Terry Gross.\u003c/p>\n\u003cp>Szalavitz is the author of \u003cem>Unbroken Brain\u003c/em>, a book that challenges traditional notions of addiction and treatment. Her work is based on research and experience; she was addicted to cocaine and heroin from the age of 17 until she was 23.\u003c/p>\n\u003cp>Szalavitz is a proponent of \"harm reduction\" programs that take a nonpunitive approach to helping addicts and \"treat people with addiction like human beings.\" In her own case, she says that getting \"some kind of hope that I could change\" enabled her to get the help she needed.\u003c/p>\n\u003chr>\n\u003ch3>Interview Highlights\u003c/h3>\n\u003cp>\u003cstrong>On the limitations of \u003ca href=\"http://www.npr.org/tags/381641163/12-step-program\" target=\"_blank\">12-step\u003c/a> programs\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The data shows that \u003ca href=\"http://www.npr.org/tags/276505286/cognitive-behavioral-therapy\" target=\"_blank\">cognitive behavioral therapy\u003c/a> and motivational enhancement therapy are equally effective, and they have none of the issues around surrendering to a higher power, or prayer or confession.\u003c/p>\n\u003cp>I think that one of the problems with the primary 12-step approach that we've seen in addiction treatment is that because the 12 steps involve moral issues, it makes people think that addiction is a sin and not a disease. The only treatment in medicine that involves prayer, restitution and confession is for addiction. That fact makes people think that addiction is a sin, not a medical problem. I think that if we want to destigmatize addiction, we need to get the 12 steps out of professional treatment and put them where they belong — as self-help. ...\u003c/p>\n\u003cp>That doesn't mean that professional treatment can't refer people to AA as a support group, but professional treatment should consist of things that you cannot get for free elsewhere.\u003c/p>\n\u003cp>\u003cstrong>On the efficacy of maintenance treatment\u003c/strong>\u003c/p>\n\u003cp>Buprenorphine and \u003ca href=\"http://www.npr.org/tags/477525967/methadone\" target=\"_blank\">methadone\u003c/a> are the two most effective treatments that we have for opioid addiction, and that is when they are taken indefinitely and possibly for a lifetime. So these medications are opioids themselves. They each have slightly different properties ... but what they do is they allow you to function completely normally. You can drive. You can love. You can work. You can do everything that anybody else does. ...\u003c/p>\n\u003cp>The way they are able to do that is because if you take an opioid in a regular steady dose every day at the same time and the dose is adjusted right for you, you will not experience any intoxication. The way people with addiction experience intoxication is that they take more and more and more, they take it irregularly, the dosing pattern is completely different. But if you do take it in a steady-state way — which is what happens when you are given it at a clinic every day at the same time — you then have a tolerance to opioids which will protect you if you relapse, and will mean that the death rate from overdose in people who are in maintenance is 50 to 70 percent lower than the death rate for people who are using other methods of treatment, and that includes all of the abstinence treatments.\u003c/p>\n\u003cp>So maintenance is a really important treatment option for people with opioid addiction. It should be the standard of care. No one should ever be denied access to it. Unfortunately, we have this idea that if you take methadone or buprenorphine, you are just substituting one addiction for another.\u003c/p>\n\u003cp>\u003cstrong>On not serving any time in prison after being caught with 2.5 kilos of cocaine when she was 20 years old\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>I have to say that being white and being female and being a person who was at an Ivy League school and being privileged in many other ways had an enormous amount to do with ... why I was not incarcerated and why I'm not in prison now. I think our laws are completely and utterly racist. They were founded in racism, and they are enforced in a thoroughly biased manner. I was extraordinarily lucky to have an attorney and a judge that saw that I was getting better, and that allowed me to avoid that.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 Fresh Air. To see more, or listen to the whole show, visit \u003ca href=\"http://www.npr.org/programs/fresh-air/\" target=\"_blank\">Fresh Air\u003c/a>.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=%27Unbroken+Brain%27+Explains+Why+%27Tough%27+Treatment+Doesn%27t+Help+Drug+Addicts&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/209896/why-tough-treatment-doesnt-help-drug-addicts","authors":["byline_stateofhealth_209896"],"categories":["stateofhealth_2746"],"tags":["stateofhealth_643","stateofhealth_2808","stateofhealth_68","stateofhealth_2810"],"featImg":"stateofhealth_209897","label":"stateofhealth"}},"programsReducer":{"possible":{"id":"possible","title":"Possible","info":"Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. 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You can also visit the MindShift website for episodes and supplemental blog posts or tweet us \u003ca href=\"https://twitter.com/MindShiftKQED\">@MindShiftKQED\u003c/a> or visit us at \u003ca href=\"/mindshift\">MindShift.KQED.org\u003c/a>","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Mindshift-Podcast-Tile-703x703-1.jpg","imageAlt":"KQED MindShift: How We Will Learn","officialWebsiteLink":"/mindshift/","meta":{"site":"news","source":"kqed","order":"2"},"link":"/podcasts/mindshift","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/mindshift-podcast/id1078765985","google":"https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM1NzY0NjAwNDI5","npr":"https://www.npr.org/podcasts/464615685/mind-shift-podcast","stitcher":"https://www.stitcher.com/podcast/kqed/stories-teachers-share","spotify":"https://open.spotify.com/show/0MxSpNYZKNprFLCl7eEtyx"}},"morning-edition":{"id":"morning-edition","title":"Morning Edition","info":"\u003cem>Morning Edition\u003c/em> takes listeners around the country and the world with multi-faceted stories and commentaries every weekday. 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