Ms. Szalavitz writes about addiction and public policy.
I had told myself that I’d never try heroin because it sounded too perfect. It’s like “warm, buttery love,” a friend told me.
When I did yield to temptation — in a fit of rage over a boyfriend’s infidelity in the mid-1980s — that’s what I experienced. It wasn’t euphoria that hooked me. It was relief from my dread and anxiety, and a soothing sense that I was safe, nurtured and unconditionally loved.
Science now shows that this comparison is more than a metaphor. Opioids mimic the neurotransmitters that are responsible for making social connection comforting — tying parent to child, lover to beloved.
The brain also makes its own opioids. These endogenous ones include endorphins and enkephalins that are better recognized for their roles in pleasure and pain but are also critical to the formation and maintenance of social bonds. One 2004 study found that infant mice without certain opioid receptors did not show attachment to their mothers.
As the United States tries to end the opioid crisis, which, according to the Centers for Disease Control and Prevention, resulted in more than 75,000 overdose deaths from April 2020 to April 2021, this biology offers important insight. America can’t arrest its way out of a problem caused by the fundamental human need to connect.
Times of uncertainty and economic inequality tend to be associated with higher levels of opioid addiction. Some of the biggest risk factors for opioid overdose are social disconnection and using alone. Pandemic lockdowns, while sometimes necessary to combat the spread of disease, increased loneliness and physical and social isolation. If policymakers want to effectively treat and prevent addiction, they need to recognize why opioids have become attractive in such circumstances. By doing so, addiction can be viewed with greater compassion.
The connections between brain opioids and motherly love were first explored by the neuroscientist Jaak Panksepp decades ago. Dr. Panksepp, who died in 2017, told me that when he first tried to publish data connecting brain opioids to attachment, he was rebuffed by a top medical journal. His research showed that morphine, in doses so low that it didn’t cause sleepiness, eased separation cries made by baby animals in multiple species.
The idea that the purest, most innocent love — between parent and child — could have any commonalities with the degradation of heroin addiction was “too hot to handle,” Dr. Panksepp told me. Today, however, decades after he published his work in another journal, what is now known as the brain opioid theory of social attachment is widely accepted.
When people nurture children or fall in love, hormones like oxytocin are released, infusing memories of being together with endorphin-mediated feelings of calm, contentment and satisfaction. This is one way that social contact relieves stress, making bonding a fundamental protector of both mental and physical health. When we are far from our loved ones or sense that our relationships are threatened, we feel an anxiety that is not unlike withdrawal from drugs.
“When people experience an opioid high, they feel warmth, safety and love,” said Steven Chang, an associate professor of neuroscience at Yale. That’s because opioid systems have evolved in part to fuel the good feelings people get from spending time with friends and family, he explained.
There are many factors that contribute to addiction, and isolation is often one of them. During the past several decades, as overdose death rates have quadrupled in the United States, social isolation has increased. One study reported that from 1985 to 2004, the size of an average American’s social network fell by a third and the number of people who said they had no one to confide in tripled. A 2018 survey found that only about half of participants felt that they had someone to turn to all or most of the time.
The pandemic may have increased this. A 2021 study found that over 60 percent of young American adults reported that they are either frequently lonely or lonely nearly all the time.
The link between opioids and feelings of love and connection also offers clues as to who is most vulnerable. People who experienced childhood trauma and neglect are at high risk for opioid addiction. People with mental illness or developmental disorders, which often bring isolation, are also highly susceptible. Low or falling socioeconomic status raises the risk for opioid use in part because it can erode social ties.
Research has also shown that low social capital, which is a measure of how much people feel connected, trust one another and are a part of their communities, is strongly linked with overdose fatalities. One study that looked closely at individual counties found that those with more civic organizations, nonprofits and greater participation in presidential elections and the census (all of which are linked to trust and social networks) tended to have far fewer overdose deaths. Conversely, neighborhoods riven by poverty tend to have less social connectedness — and more overdoses.
Understanding the social nature of opioids and addiction should help policymakers better care for those who suffer from it.
Instead of punishment, people with addiction need the chance to learn healthier ways of coping, which will require a variety of resources. Some need psychiatric medications, including opioids themselves. (Long-term use of methadone or buprenorphine is the only treatment proven to cut the death rate from opioids by half or more.) Some need therapy or stable housing or meaningful work. Some need new friends, and many need all of the above.
None need jail simply for trying to feel OK. To paraphrase the writer Johann Hari, the opposite of addiction isn’t abstinence. It’s love.
Maia Szalavitz is the author of, most recently, “Undoing Drugs: The Untold Story of Harm Reduction and the Future of Addiction.”
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