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GUY RAZ, HOST:

It's the TED Radio Hour from NPR. I'm Guy Raz. And on the show today, Confronting Stigma - ideas about why we judge certain behaviors and conditions, and how those judgments can make it all the more difficult to honestly talk about them or even deal with them in a constructive way, like how we deal with drug addiction.

JOHANN HARI: You know, I - one of the most shocking things that I learned in my research was that I had completely misunderstood what I thought I'd seen right in front of me. So I'd been watching people I love with addiction problems since I was a child, and I thought I understood why it had happened.

RAZ: This is journalist Johann Hari. A few years ago, he wrote a book about drug addiction and the war on drugs called "Chasing The Scream."

HARI: So if you'd said to me, you know, when I started doing the research, what causes, let's say, heroin addiction? I would've looked at you like you were an idiot. I would've said, well, obviously, Guy, heroin causes heroin addiction. That's - the clue is in the name, right?

RAZ: Right, yeah.

HARI: We think if we seized 20 people off the street and like a villain in a "Saw" movie, we forcibly injected them all with heroin every day for a month, at the end of that month, they'd all have an addiction problem for the obvious reason that there are chemical hooks in heroin that their bodies would start to kind of desperately physically need, and that's what addiction is, right? I thought I'd seen that happen.

RAZ: That's - well, that's what we all assume, right? You take heroin for 20 days, you're probably going to be addicted.

HARI: Exactly. And I only began to understand what's really going on and, in fact, what had gone on in my family when I went and met an incredible professor called Bruce Alexander in Vancouver. And Professor Alexander explained to me, this theory of addiction that I had in my head - that it's caused by the chemical hooks - comes from a series of experiments that were done earlier in the 20th century. You take a rat, and you put it in a cage, and you give it two water bottles. One is just water. The other is water laced with either heroin or cocaine. If you do that, the rat will almost always prefer the drugged water and almost always kill itself quite quickly. But Professor Alexander was looking at these experiments in the '70s, and he had this kind of realization. Wait a minute. We put the rat alone in an empty cage. It's got nothing to do except take these drugs.

RAZ: Yeah.

HARI: What would happen, he thought, if we did this differently? So he built a cage that he called Rat Park, and it's basically heaven for rats, right? They've got loads of friends. They got loads of grain. They got loads of tunnels to scamper around. They can have lots of sex. And they've got both the water bottles - the normal water and the drugged water. But this is the fascinating thing. In Rat Park, they don't like the drugged water. None of them ever used it compulsively. None of them ever overdosed. So you go from almost 100 percent compulsive use of overdose when their lives are bad to none when their lives are good and they have the things that make life meaningful for rats.

RAZ: Now, even though this study in the 1970s was just for rats, it turns out there was a similar scenario playing out for humans at the exact same time. Johann Hari picks up that story from the TED stage.

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HARI: It was called the Vietnam War. In Vietnam, 20 percent of all American troops were using loads of heroin. And if you look at the news reports from the time, they were really worried because they thought, my God, we're going to have hundreds of thousands of junkies on the streets of the United States when the war ends. It made total sense. Now, those soldiers who were using loads of heroin followed home. The Archives of General Psychiatry did a really detailed study. And what happened to them? It turns out, they didn't go to rehab. They didn't go into withdrawal. Ninety-five percent of them just stopped.

Now, if you believe the story about chemical hooks, that makes absolutely no sense. But Professor Alexander began to think there might be a different story about addiction. He said, what if addiction isn't about your chemical hooks? What if addiction is about your cage? What if addiction is an adaptation to your environment? Looking at this, there was another professor called Peter Cohen in the Netherlands. He said, maybe we shouldn't even call it addiction; maybe we should call it bonding. Human beings have a natural and innate need to bond. And when we're happy and healthy, we'll bond and connect with each other. But if you can't do that because you're traumatized or isolated or beaten down by life, you will bond with something that will give you some sense of relief. Now, that might be gambling. That might be pornography. That might be cocaine. That might be cannabis. But you will bond and connect with something because that's our nature. That's what we want as human beings.

RAZ: But, I mean, here's the thing, Johann. I mean, there are people who come from stable backgrounds who don't have difficult external conditions in their lives and who don't have that single-rat-in-a-cage situation, and they still become addicts. I mean, that happens. That's not totally uncommon.

HARI: Yeah. So I've discussed this with lots of the experts and scientists I spoke to. And as I spoke to them and assimilated what they've found in their research, I began to think this analogy. So if you read kind of early feminist texts from the '60s like Betty Friedan, there's a recurring thing that happens, a recurring scene where a housewife in the 1950s will go to her doctor and she would say something like, Doctor, something terribly wrong with me because I've got everything a woman could possibly want. I've got a husband who doesn't beat me. I've got a washing machine. I've got two kids, and I've got a car, but I still feel terrible.

Now if we could go back in time and speak to those women, what we would say is, wait, you've got everything you could possibly want by the standards of the culture, but the standards of the culture are just wrong. You need much more than this. And I think, in the same way, when I speak to people who say, what you're saying can't be right because I had everything I could want, and yet, I still felt profoundly terrible and became addicted, are their psychological needs actually being met? Do they feel that their life is meaningful, that they are connected to deep meaning? Do they feel they belong? If you actually talk about those questions, which are much more important than whether you've got money, actually, I think it demonstrates that their values - that they didn't have the things people want. The opposite of addiction is not sobriety. The opposite of addiction is connection.

RAZ: Now, to be clear, Johann isn't saying there's absolutely no biological basis for addiction. But what he is saying is that an environment steeped in shame and stigma can make it so much easier for people to turn to drugs.

HARI: In the run-up to the 2016 election, I was writing about some people who were doing a get-out-the-vote work. And we were on this long street in a place called Slavic city (ph) in Cleveland, and it was one of those streets where a third of the houses had been demolished, a third had been abandoned, and a third still have people living in them - huge addiction problems, as you could just see walking around. And we knocked on one door, and there was a woman. I don't know if she had an addiction, but I strongly suspect she did. And we were talking, and she was actually very articulate. She was very angry. And she said something that has absolutely haunted me.

She was talking about what the area used to be like, how everything that made the area make sense - the work, the sense of regularity, the sense of the future - was all gone. And she trying to describe what the area used to be like, and she meant to say, when I was young. What she actually said is, when I was alive. And I really reeled back, and I understood why this woman was so angry, and I understand why people who feel like that - when I was alive - right? - when the things that made sense when there was a community, when there was a sense of the future - if you take those things away from people, they will be in terrible despair.

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HARI: In the year 2000, Portugal had one of the worst drug problems in Europe. One percent of the population was addicted to heroin, which is kind of mind-blowing. And every year, they tried the American way more and more. They punished people and stigmatized them and shamed them more, and every year, the problem got worse. And one day the prime minister and the leader of the opposition got together and basically said, look, we can't go on with a country where we're having ever more people becoming heroin addicts, and they start a panel led by an amazing man called Dr. Joao Goulao to look at all this new evidence. And they came back, and they said, decriminalize all drugs from cannabis to crack, but take all the money we used to spend on cutting addicts off, on disconnecting them, and spend it instead on reconnecting them with the society. And that's not really what we think of as drug treatment in the United States and Britain.

So they do do residential rehab. They do do psychological therapy that does have some value. But the biggest thing they did was the complete opposite of what we do - a massive program of job creation for addicts and microloans for addicts to set up small businesses. So say you used to be a mechanic. When you're ready, they go to a garage, and they'll say, if you employ this guy for a year, we'll pay half his wages. The goal was to make sure that every addict in Portugal had something to get out of bed for at 4 in the morning. And when I went and met the addicts in Portugal, it was fascinating. What they said is, as they rediscovered purpose, they rediscovered bonds and relationships with the wider society. It'll be 15 years this year since that experiment began, and the results are in. Injecting drug use is down in Portugal, according to the British Journal of Criminology, by 50 percent. Addiction in every study is significantly down. One of the ways you know it's worked so well is that almost nobody in Portugal wants to go back to the old system.

RAZ: It's amazing to me, like, that at a certain point, Portugal was looking at their problem and they said, stigmatizing this is not working. All of the evidence has shown that that does not work. But if everybody knows this - I mean, that evidence is available to you and me, to our political leaders. It's available to societies all around the world. So what's the problem? I mean, why do most of us continue to treat addiction in the way we do?

HARI: I think it's a few things. One is, people like me haven't done a good enough job of explaining what the alternatives mean. So when you talk about decriminalization or legalization - which happened in Switzerland - of heroin with incredible results that I can tell you about, what people think we're saying is, there should be, you know, a heroin aisle in your local CVS, and, you know, we want kids to use heroin and, you know, which, of course, literally nobody wants.

RAZ: Right.

HARI: And so we need to do a much better job of communicating what we're actually in favor of. And, you know, Switzerland is a great example. Switzerland at the same time as Portugal had this huge heroin problem. They tried a slightly different approach. They got an incredible female president called Ruth Dreifuss, and Ruth explained to the Swiss people, when you hear the idea of legalizing heroin, what you picture is anarchy and chaos. What we have now is anarchy and chaos. We have unknown criminals selling unknown chemicals to unknown drug users all in the dark, all filled with violence and disease. Legalization is the way we restore order to this chaos.

So what they did is they - if you had a heroin problem, you were assigned to a heroin clinic. I spent a load of time in the one in Geneva, which, by the way, Ruth Dreifuss lives opposite, which I think tells you something. And you're assigned to this clinic. You go in. You're given your heroin there. You can't take it out with you. You're watched by a nurse as you use it. And then you leave to go to your job because you're given loads of support to turn your life around.

The results in Switzerland have been extraordinary. There have been zero deaths on overdose on the legal heroin program since it began more than 15 years ago. I just want to repeat that. Literally nobody has died on legal heroin program. The United States, your listeners don't need me to tell you, has had somewhat different outcomes. More people have died of heroin overdoses and opioid overdoses since you and I started talking in this conversation, Guy, than have died in the last 15 years in Switzerland.

RAZ: Wow.

HARI: So at some point, we have to look at - you know, we all have anger about addiction and depression. At some point, we have to look at the results. Policies based on stigma and shame kill people. They are deadly. And policies based on love and compassion work much more - there's no silver bullet. There are still problems in Portugal and Switzerland, but their lives get better. For a hundred years now, we have been singing war songs about people with addiction problems. We should've been singing love songs to them all along.

RAZ: Journalist Johann Hari - his most recent book is called "Lost Connections: Uncovering The Real Causes Of Depression - And The Unexpected Solutions." You can see his full talk at ted.com. On the show today, ideas about stigma. I'm Guy Raz, and you're listening to the TED Radio Hour from NPR.

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