The Biology of Desire: Why Addiction is Not a Disease (Marc Lewis)
Scribe Publishing, London - 2015 - pb:
Dr. Marc Lewis is a neuroscientist and professor of developmental psychology, now teaching at Radboud University in the Netherlands after more than twenty years on faculty at the University of Toronto. He has authored or co-authored more than fifty journal articles in neuroscience and developmental psychology. Presently, he speaks and blogs on topics in addiction science, and his critically acclaimed book, 'Memoirs of an Addicted Brain: a Neuroscientist Examines his Former Life on Drugs', is the first to blend memoir and addiction studies.
The crux behind this book is the result of Dr. Lewis's interaction with five people who journeyed into and out of addiction and resolve to assert that the 'disease model' of addiction is wrong, and goes on to suggest other routes to recovery. A chapter covers each of these people individually. Natalie's addiction is illegal drugs, particularly heroin and then there is Brian and his romance with Meth. Likewise, Donna, Johnny (alcoholic) and then Alice with eating disorders are all sympathetically addressed along with each individual's circumstances and causations towards addiction.
Chapter one concentrates on defining addiction and is followed up in the next chapter with an explanation of why the brain is designed for addiction. The concluding chapters are given to explaining why addiction is more than just a disease including biological and biographical causalities. Lewis notes that pharmaceuticals are far from fool-proof and not only that, can actually prolong the addiction and therefore he advocates developing other routes beyond addiction. He suggests real life recovery, involving 'saying no' and/or cultivating openness are key as tactics and if pushed to choose just one it would be openness leading to perspective change.
Dr. Lewis draws on a number of experiments, some which we are familiar with. One of these include three year olds and the scenario where they can have one sweet item (in this case marshmallow) or if they can resist temptation for the desired time receive a second. He compares this with the dilemma which addicts find themselves in time after time and points to the reason being striatal dopamine. Brains are designed to restructure themselves with normal learning and development, but this process is accelerated in addiction when highly attractive rewards are pursued repeatedly. Lewis also perceives addiction to be an unintended consequence of the brain doing what it's supposed to do. That is seek pleasure and relief but is countered in a world that is not collaborating.
This of course goes against much of the psychiatric establishment and rehab industry in the Western world maintaining addiction as a brain disease, based on evidence that brains change with drug use. The scientific community including medical doctors and psychiatrists state very clear that it is a disease and should be approached no differently from the way we approach heart disease or cancer. The American Society of Addiction Medicine makes it explicit in the definition it provides on its website: 'Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry'.
Marc Lewis maintains that the medicalisation and disease model have now outlived their usefulness which leaves us with an interesting position. Who do we side with? His own experience, recovery and academic career that followed does allow us an insight into alternatives and as we are already aware there are no absolute fixes. What this book does is give us a greater understanding of addiction, how the brain works and why it changes. Marc Lewis will be speaking about addiction in mind and brain and the standoff between desire and dread at the OUPS Conference on Saturday 6th May.
You can also tune into his talks on YouTube by following the following links:
- Marc Lewis: Learning Addiction, Festival of Dangerous Ideas, 2015
- Dr. Marc D. Lewis on Memoirs of an Addicted Brain, 2012