On Transportation and Addiction

American’s love of the car and the freedom it has symbolized for 100 years is killing us.

The U.S. is one of only three counties to have rising road deaths among all other OECD nations. In 2021, 43,000 people died in vehicle related crashes. And despite pedestrian deaths by vehicle dropping dramatically from 1980 to 2009, a reversal is significantly underway , with a particular rise with nighttime deaths. The New York Times?podcast The Daily provides an excellent breakdown of the data and why this might be happening.?

But what does this have to do with addiction??

Everything. ?

When you hear or say the word addiction, you likely associate that word with drugs and maybe alcohol. You may have even had a quick flash of a stereotypical person with addiction. Unfortunately, as Dr. Peter Attia said on the Prof G podcast (yeah, I listen to a lot of podcasts), “... most of us are addicts.”?

Everyone is addicted to something. Dr. Attia explains:?

“The question is, ‘what are we addicted to?’ And I tend to not worry so much about what the label is and tend to really ask myself is, ‘is the behavior adaptive or is it sort of bleeding into maladaptive?’ And I think to answer that question you have to have a really clear sense of what your values are.”?

Society has long shared a belief that only certain people are addicts or suffer from addiction. Over the last decade, advocates have tried to dispel that belief with a new belief that addiction does not discriminate. “It can happen to anyone,” they say, “rich or poor, black or white, urban or rural.”?

This is where we could tie ourselves in knots around the science and symptoms of addiction. Is it strictly a brain disease? Are environmental factors greater than behavior, greater than genetic. What role does choice play??

All of that is for another essay.?

Let’s use Dr. Attia’s framing around adaptive and maladaptive behaviors.

Maladaptive behaviors are usually behaviors that emerge to hinder your ability to adapt to daily situations and stress in healthy ways. Using alcohol or drugs to manage stress, anxiety, or other emotions is a maladaptive behavior. ?

Addiction mostly results when that maladaptive behavior – using alcohol to cope with anxiety – moves beyond dependence and becomes repeated negative consequences despite knowledge and understanding of those consequences.?

Nir Eyal has posited a reframing of addiction in the context of technology products – but which I believe can be extended to other things like substances, behaviors, and even cars. Eyal has observed that:?

Addiction only occurs at the unfortunate collision of three factors:?

1. a product that relieves discomfort?

1. a person otherwise unable to cope, and?

1. a source of pain they are ill-equipped to handle.?

Yeah, there’s a lot more people experiencing addiction beyond just drugs and alcohol.?

Which gets us back to transportation and the car.?

Despite the data around pedestrian deaths and knowledge that we buy bigger vehicles and design cities for cars, not pedestrians, we keep buying the machines that kill and injure our neighbors. Far more people are injured and not killed than killed each year. According to the CDC , an estimated 104,000 emergency department visits were logged in 2020 due to pedestrians being treated for non-fatal crash-related injuries. ?

We’re addicted to the car. ?

I see it every day in my small village in northern New York. I walk the dog each morning and a few times a week will walk to run errands – I’m a 10-minute walk from downtown. People in their cars are regularly hostile to me and other pedestrians – honking for people to cross faster, immediately accelerating as soon as you clear the road, and driving 10-15 miles an hour over the speed limit in residential areas. ?

It’s as if we are a nuisance.?

And the nuisance extends beyond being in the car. We live in a village that has the responsibility for clearly sidewalks of snow – not the home or lot owner. This is a problem when it snows (like this weekend). People have been relieved of the duty to clear sidewalks, so walking is made more treacherous as many of us will move into the street for easier passage – but this is a death sentence.?

What we care about, and what is reflected in the village action, is immediate and continuous road clearing during a snowstorm. Sidewalks are the very last to get cleared. We got 5 or 6 inches of snow, and as much as I and my dog love the exercise and joy of walking through the snow, the sidewalks won't get cleared until mid week.?

Again, this is a symptom of our collective addiction to the car.?Or as Attia points out, a reflection of our values.

According to a survey on car ownership conducted by The Zebra in 2020:?

• 93% of U.S. households had access to at least one car in 2019.?
• The average American household owns at least two cars.?
• 77% think owning a car is necessary.?
• Only 14% think public transportation is easier and cheaper.?
• 38% never use public transportation.?
• 57% could not get to work easily without a car.?

There are three commonalities I see when looking at the pedestrian fatality data:?

1. High individualism. Cars have highlighted the security a single person gets when they are in the car. Everything outside the car does not matter, just me, where I'm going, and what's happening inside my large, comfortable, metal box.?

1. Higher acceptance of risk. Cars are (generally) safer (for those in them), and roads are significantly wider, which inhibits the willingness to drive faster and more recklessly. Our relationship to the risks of driving is wildly disconnected to reality, especially a reality with significantly (there's that word again) more distractions in the car.?

1. Addiction to immediate gratification. See point 1 and look at the increasing inability of people to delay gratification. People want to get where they are going as fast as possible. Get through the light -> dopamine hit. Zoom around traffic -> dopamine hit. Get text and respond to text -> dopamine hit. Doing that while going 60 miles an hour in a 45 mph zone -> dopamine hit.?

We love our cars and how they make us feel. Let's apply the Nir Eyal elements of addiction:

1. Our cars relieve some discomfort in our lives. Work and home are stressful. But we get in the car with it's multizone air conditioning, heated or massage seats, and our music or podcasts. It's a sanctuary from the drama outside those four walls.
2. We use the time in the car to decompress instead of engaging other behaviors or strategies for the discomfort we feel.
3. Cars isolate us, exacerbating our issues.

But, if we do not have a car to get where we need to go, we can be thrust into a whole different realm of feelings and issues.

Almost 60% could not get to work easily if they did not have a car. This is a problem for the average person – now imagine you are overcoming a serious drug or alcohol problem. Because of that problem, you do not have a driver’s license and/or you cannot afford a vehicle. ?

In most of the studies on reasons why people return to problematic substance use, life stressors are usually in the top five. Most of these studies don’t get specific, but in my experience, transportation is a major issue.?

If you cannot navigate your community effectively, you continuously risk missing appointments, job interviews, pro-social gatherings, etc. Unfortunately, the deeply trained maladaptive behaviors of the past take over.?

We’ll solve addiction when we don’t solve for addiction.?

I write and explore addiction through topics like the car, pedestrian fatalities, and transportation because solutions for addiction cannot only be about treatment and recovery support. We need those things – but we need to recognize that for statistical impact, we must move our solutions into the design and operation of our communities.?

Usually there are two counter arguments to my upstream thinking: (1) Not my problem; and (2) You cannot prove a negative. ?

The not my problem crowd says, “I don’t have addiction. I follow the rules. I work hard and I want a big SUV and 5,000 square foot single family home. If you can’t get your shit together, that’s not my problem. I can get around town just fine.”?

See the issue of high individualism above.?

Then there’s the more enlightened group that says, “Even if you add roundabouts and better public transportation and make the community more walkable and increase mixed-use zoning ... you can never prove any of that actually caused a reduction in addiction or improved overall wellbeing.”?

There’s a lot of things we cannot directly prove, but we still believe in it or do it.?

These arguments were lobbed at the mayor of Carmel, IN when he wanted to eliminate traffic lights due to very high rates of crashes, injuries, and deaths at intersections. After adding dozens of roundabouts throughout the city, injury crashes were reduced by 47% . What effect has that had on the health and wellbeing of Carmel residents? I don’t know but I suspect for those not having to deal with a crash and all that goes with it (maybe even addiction after being prescribed an opioid, etc.), they are happy not knowing. ?

The “not my problem” and “you can’t prove the negative” positions are essentially denialism – a hallmark behavior of a person with addiction.?

We have an addiction to cars and unfortunately it is killing and injuring us at alarming rates. And it's making it ever less safe to live in cities and suburbs in the U.S. But apparently, it’s not bad enough for us to do something about it – which again, is typical addictive behavior. ?

If you want to go down the rabbit hole on this topic, I highly recommend starting with CityNerd (aka Ray Delahanty ) on YouTube. There are three videos that the absurdity of our addiction as seen through the lens of city and urban design:?

• The Insane Ways Traffic Engineers Try to Make Streets “Safe” For Walking ?
• A Peek Inside Car-Brain: 10 US Cities Where the Cycle of Car Dependency Has Spiraled Out of Control ?
• Car crashes in the US: Who’s Responsible, Who Bears the Costs, and How We Talk About It (with Data) ?