by Johann Hari
Long before, one of Billie Holiday’s friends, Memry Midgett, told an interviewer: “The reason for her being an addict24 was because she had a tremendously poor threshold of pain.” Another of her friends, Michelle Wallace, said: “People think sometimes25 people use drugs because they’re bad or evil. Sometimes . . . the softest people use drugs, because they can’t take the pain.”
This helps, I realize, to explain the previously mysterious gap between the 10 percent of drug users who sink into addiction and the 90 percent who don’t. A man named Bud Osborn, who was helped to recover from his heroin addiction by Gabor, tells me: “The childhood trauma makes you feel bad about everything. Bad about your family, bad about life,” he said. “And then when you take drugs, they make you feel good about your life, about yourself, about being in the world . . . [People] wonder—why do [addicts] keep doing it? Because it makes them feel good, and the rest of their life doesn’t make them feel good.”
Some people, after absorbing all this, would develop an idealized or sanitized picture of addicts. This was not an option at the Portland Hotel Society.
Gabor was often spat at and told to fuck off. The staff there have had shit—literal shit—flung into their faces.26 One of Gabor’s patients, Ralph, was a middle-aged coke addict with a dyed Mohawk and a Hitler mustache. He was a Nazi, and he taunted Gabor by muttering “arbeit macht frei.” When Gabor explained his grandfather died in a death camp where those words were displayed over the gates, Ralph said his grandfather had it coming.27
Sometimes Gabor snapped. One day he said to me, “I’m lancing an abscess on somebody and [the patient] keeps attacking me verbally and I totally lose it. In the end, I’m waving this bloody scalpel around. I wasn’t hurting anybody with it, but emotionally I lost it. That happened a number of times. In those moments you don’t think—you just emote. Frustration. Anger. Judgment.”
He understood how these emotions intrude on the public debate about addicts because even he, after all he has uncovered, couldn’t scour them out of himself. But, he added, “Once I calmed down, shame comes into it, and I want to apologize.”
Some days, Ralph was quiet and reflective and recited passages of Goethe’s poetry28 to Gabor. The next week, he was back to muttering “Heil Hitler.”29
Gabor felt there was much more to investigate about addiction, but he was distracted by something he didn’t like to discuss. He hid it from everyone, even his wife.
Quite often, he would be in the middle of his medical duties when he would feel an overpowering urge. It was a compulsion that forced him to drop everything. He would rush to music stores and compulsively spend hundreds of dollars on CDs. Usually, he didn’t even listen to them: he simply stashed them. This might sound harmless, until you hear that he was in the middle of delivering a baby one time when he felt the compulsion and had to run away to binge on CD buying.30 When his kids were still small, he abandoned them in public places to rush away to buy music. Why was he doing this? He didn’t understand it. He only knew that, as he would write later, “I lose myself when caught in one of my addictive spirals. Gradually I feel an ebbing of moral strength and experience myself as hollow. Emptiness stares out from behind my eyes.”31 At times, it made him feel blackly depressed; at times he felt suicidal.
Yet once Gabor learned that there was a connection between traumatic early childhoods and compulsive behaviors, he began to think about what the doctor told his mother all those years ago: “All my Jewish babies are crying.”
The babies obviously couldn’t know that a genocide was taking place, but they did know, on some level, that their mothers were distraught and not able to meet their needs. His own mother, he says, “was stressed, depressed. She said the only reason she got out of bed was to look after me. So I saved her life. It’s a hell of a responsibility for a four-month-old, to save his mother’s life . . . She carried tremendous pain . . . tremendous grief, and as an infant, you absorb all that.” So he developed differently from a baby whose mother was able to offer calm and consistent love. Now, as an adult,32 he found himself unable to control himself at moments of stress. For him, the outlet was to buy music. He realized that when he was a small child, there was one thing that relaxed his mother, and so, in turn, relaxed him. She would listen to music. Now it was the thing he tried to buy and hoard, as if it held the secret key to being calm.
He saw a similar dynamic at the Portland, only the residents’ experiences were “not like my childhood. They’re much worse,” he tells me. “While the historical circumstances might be more horrifying in my case, the actual personal experience was far more traumatic in the case of my clients.” He says this is “because I wasn’t traumatized by my parents’ psychological dysfunctions . . . The trauma I sustained was the trauma they sustained . . . It came from the outside. But once my parents were united, we had a stable family life. I was not abused . . . It’s nothing like being sexually abused by your father or your mother. It’s nothing like being ignored by your addicted parents who are out carousing while you are left alone.”
Gabor’s trauma was mild, so his addiction was mild: he can bear to be present in the world most of the time. His patients’ trauma was extreme, so their addiction is extreme: they can bear to be present in the world very little of the time. But—crucially—in both cases, something had gone askew, he explains, “before the use of33 mind-altering substances begins.”
I find myself walking in circles through the Downtown Eastside after one of my conversations with Gabor, past addicts who are half collapsed on the street. They are wearing the exaggerated stage makeup of the street prostitute, or hawking drugs or random items they have discovered in dumpsters—old VHS tapes and half-broken shoes. They shout and holler, at me, and at the world.
I picture the look of judgment on the faces of people who stumble into this neighborhood by mistake. I can see them now. The people from stable families, who glance at addicts and shake their heads and say, “I would never do that to myself.” I feel an urge stop them and wave Gabor’s statistics in their face and say—Don’t you see? You wouldn’t do this to yourself because you don’t have to. You never had to learn to cope with more pain than you could bear. You might as well look at somebody who had their legs amputated in a car crash and declare: “Well, I would never have my legs cut off.” No. You haven’t been in a car crash. These addicts—they have been in car crashes of the soul.
And then, just as I am rehearsing this self-righteous lecture in my mind, I notice that I, too, am hurrying past the street addicts, with a look on my face that seems a lot like—what? Fear? Disgust? Superiority? Recognition?
All this information had been available in scattered sources before Gabor began to write about it. But, he told me, “What absolutely surprised me was that all this information hadn’t been brought together before. Nobody had brought together childhood trauma, brain development, and the stories of the addicts that we work with, to provide a coherent theory of addiction.”
But—as Gabor is the first to point out—even with these discoveries, our picture is still incomplete. It plainly cannot be the case that all addicts were treated appallingly as kids. It is an important factor in addiction—but it is not enough. As Gabor worked at the Portland, not far away, on another part of the Downtown Eastside, another man was working, a professor named Bruce Alexander. He agreed with Gabor’s analysis about childhood trauma, but he was trying to answer this further question. Some people do not have traumatic childhoods, yet they still become addicts. What, he wanted to know, is going on with them?
As I sat with Gabor over dinner in a Greek restaurant near the end of my time with him, I kept thinking: How should the facts he has uncovered change the way we think about the drug war?
He has shown that the core of addiction doesn’t lie in what you swallow or inject—it’s in the pain you feel in your head. Yet we have built a system that thinks we will stop addicts by increasing their pain. “If I had to design a system that was intended to keep pe
ople addicted, I’d design exactly the system that we have right now,” Gabor would tell me. “I’d attack people, and ostracize them.” He has seen that “the more you stress people, the more they’re going to use. The more you de-stress people, the less they’re going to use. So to create a system where you ostracize and marginalize and criminalize people, and force them to live in poverty with disease, you are basically guaranteeing they will stay at it.”
“If negative consequences led people to transformation then I wouldn’t have a single patient left,” he says, “because they’ve experienced every negative consequence in the book. Being jailed. Being beaten up. Being traumatized. Being hurt. HIV. Hepatitis C. Poverty.” Gabor looks at me, his eyes sagging a little, as if picturing it all. “What haven’t they suffered yet?”
But what if we replaced this war on addicts with a war on the causes of addiction?
Gabor says that since child neglect and abuse is a major cause of addiction, if we were serious about reducing the number of addicts, we would start “at the first prenatal visit, because already the stresses on the pregnant woman will have an impact on the potentially addictive propensity of the child.” We would identify the mothers who are most stressed and least able to cope, and we would give them extensive care and support and coaching in how to properly bond with their child.
Then, after birth, we would keep carefully identifying mothers who are having problems bonding with their babies and offer them wrap-around care. We would be highly vigilant for the parents who still can’t provide a safe home, or who become abusive, and find an alternative loving home for the child if we had to. These are approaches that would, over time, reduce addiction, instead of deepening it, as our current strategy does. Of course, services to help mothers and vulnerable kids already exist in all developed societies, but outside Scandinavia, they are usually threadbare and chronically underfunded. Wouldn’t it be better to spend our money on rescuing kids before they become addicts than on jailing them after we have failed?
Of all the ideas I have heard, this seems to me to be the one that would have been most likely to save the life of Chino’s mother, and Marcia Powell, and Billie Holiday. It sounds persuasive, I tell Gabor. But what about once an adult addict has already been created? What can we do for them?
For the last ten years of her life, Hannah—the addict who had been removed from her reservation and then starved in a room for three years as a girl—lived in her own suite at the Portland Hotel Society, where she was surrounded by people like Liz and Gabor who listened to her and reassured her she would never be cast out again.
Liz helped her to find the family she had left behind on the reservation all those years ago. Her family came to visit her in her own room at the Portland, and she cooked for them, and she felt proud. When Hannah would fall into her furies and call herself a worthless junkie, Liz said to her: “You are an amazing human being . . . You show more resilience and tenacity and strength than any person I know . . . You’re strong. You’re beautiful. Can you tell yourself today you did an amazing job surviving?”
Hannah never stopped seeking out abusive relationships, and she never stopped drinking, although over time she did transfer from heroin to methadone. She had contracted the HIV virus back when there were no needle exchanges in the city, and so she died in the hotel of AIDS at the age of forty-eight. Because of the Portland, she did not die alone. She was surrounded by people who loved her and admired her.
To the prohibitionists, Hannah is a failure, because she continued using drugs. To the Portland, she was a success, because she knew she was loved.
One day, a very senior government minister came to visit the safe injection rooms, and to meet the addicts. He asked Liz: “What percentage of people who use this place would you consider to be write-offs?”
She paused and looked at him, trying to figure out how to tell him that the answer is none.
Chapter 13
Batman’s Bad Call
Bruce Alexander received his first lesson about addiction from Batman. As a small kid, he grew up on a series of military bases of the United States, where his father was a training officer. One day, he was reading a comic in which a group of crooks beat up a junkie while Batman hid behind a building, watching, impassive.
“Dad,” Bruce asked, “why would Batman just hide there while they’re beating this junkie to a pulp? Isn’t it Batman’s job to stop criminals?”
“Well, really, no one cares if they beat a junkie to a pulp,” his dad replied, “because they’re worthless human beings.”
Bruce believed it. Yet as an adult, on the streets of the Downtown Eastside, he was going to make two of the most important breakthroughs about addiction in the twentieth century—ones that would overturn everything we have been taught.
I first heard about Bruce years ago when I was studying psychology at Cambridge University, and I read about an experiment1 he had conducted on rats. At first, it sounded quirky and intriguing, nothing more—but I found that his experiment kept coming into my mind at unexpected moments for years and years. It was only when I decided to begin this journey into the drug war that I resolved to dig deeper.
I met Bruce in the café on the first floor of the library in Downtown Eastside. It is a Spartan place with hard chairs and track lighting, and almost everybody there that fall day seemed to be homeless addicts, warming themselves with weak coffee. Bruce looked a little incongruous there at first: he is a genial gray-haired man in his sixties who looks like both the professor he is, and the Canadian he has become. He wore a smart sweater and a friendly smile. Soon, it became clear to me that my first-glance impression was wrong: he does belong here. Not long after we started talking, we were interrupted by an addict who has known him for years—and knew about his work and what it meant for her. After she had gone, he began—then, and over several subsequent interviews—to tell me the story of his experiment. It was going to change how I thought—about addiction, about some of the people closest to me, and about the world.
In the early 1970s, Bruce was a young professor of psychology at Simon Fraser University in British Columbia, Canada. He was told by the faculty to teach a course called Social Issues that nobody else wanted to bother with. He knew the biggest social issues of the day were the Vietnam War and heroin addiction, and he couldn’t go to Saigon, so he went to the Downtown Eastside. He headed there wearily, to learn just enough to explain it to his students, and no more. The same parade of addicts that Gabor would see years later passed before him on the streets, and he thought of them just as Batman taught him to—as zombies whose minds have contracted to the single drooling dimension of their drug.
Since Bruce was trained in family therapy, he figured that the best way to bring himself up to speed would be to provide counseling to addicts at a local treatment agency.
One of his first patients was Santa Claus. Every Christmas, this man was employed at the local shopping mall, where he would arrive in a helicopter, climb down a rope ladder, ho-ho-ho at the local children, use some smack backstage, and then promise to grant their wishes. Bruce persuaded Santa Claus to invite his parents in for family therapy, since behind the beard and the reindeer, he was only twenty-three. The parents were terrified their son would die; the son felt he couldn’t stop. And one day, they were discussing his work as a smacked-out Santa, and they all began to laugh helplessly.
Something about this pricked at Bruce. He had been taught to believe addicts were incapable of self-reflection—yet this young man could see the absurdity of his situation clearly. There was a humanity in this laughter that Bruce had not expected to hear.
He continued to interview addicts in depth. Like Gabor, he could see that childhood trauma was a crucial factor. But he was also discovering facts that were deeply confusing to him and, at first glance, to everyone.
There were big chunks of time in the 1970s in which the Canadian police managed to blockade the port of Vancouver so successfully that no heroin was getting into th
e city at all. We know this because the police tested the “heroin” being sold on the streets and found it actually contained zero percent of the drug: it was all filler and contaminants. So the war on drugs was, for some significant stretches, being won here.
It is obvious what should have happened during these heroin droughts. The heroin addicts should all have been plunged into physical withdrawal, writhing in agony, and then, weeks later, they should have woken up to find they were freed from their physical dependency.
But Bruce was seeing something really weird instead. There was no heroin in the city—but all the heroin addicts were carrying on almost exactly as before. They were still scrambling desperately to raise the money—robbing or prostituting—to buy this empty cocktail. They weren’t in agonizing withdrawal. They weren’t getting gut-wrenchingly sick. They thought the “heroin” they were buying was weak, to be sure, and they were topping it up with heavier drinking or more Valium. But the core of their addiction didn’t seem to be affected. Nothing had changed.
This wasn’t some freak2 event: a similar effect was being seen in other North American cities where heroin was successfully blockaded for a while, either by police action or by strikes on the docks that prevented anything being unloaded.
This is perplexing. You can get rid of the drug—yet3 the drug addiction continues in pretty much the same way. What could possibly be happening here?
Bruce went back and taught his students that drug addiction must have much less to do with the actual chemicals than we commonly assume. They had—like all of us—been told that one of the worst aspects of heroin addiction is the fierce and unbearable sickness of physical withdrawal. Henry Smith Williams believed this process was so harrowing it could kill you. But Bruce saw addicts in withdrawal all the time—and their symptoms were often minor:4 at worst, like a bad flu. This is so contrary to what we are told that it seems impossible, but doctors now very broadly agree it is the case. The real pain of withdrawal is the return of all the psychological pain that you were trying to put to sleep with heroin in the first place.