Author Marc Lewis is a neuroscientist. He was with the University of Toronto from 1989 to 2010 and is presently at Radboud University in the Netherlands. He is also a former drug addict.
He stopped using at the age of thirty. “I needed to find out what had happened to me all those years ago. How had my brain become so addled for such a long time? How did I finally quit?” The Biology of Desire presents the stories of five addicts as well as research results.
I thought Lewis was repetitive and must admit I did not read the entire book. You’ll get the gist of Lewis’ argument from the Introduction and first and last chapters. The rest of the book is intended to prove his case and provide individual stories as “scaffolding” for the book to show “what it’s like when addiction takes hold.”
Disease Model is Wrong
Lewis’ goal is to argue that the dominant model of addiction as a disease is wrong. Addiction is an extreme example of normal brain functioning, a neurochemical feedback loop of desire (desire is not the same thing as pleasure) that is “an inevitable feature of the basic human design.” He presents lots of explanation of how dopamine acts in the brain to establish both normal and destructive habits – it’s the same mechanism for love and addiction.
The book isn’t as depressing as viewing addiction as the far end of normal might make it sound. “[Of the] heroin-addicted veterans of the Vietnam War, about 75 percent… kicked the habit once they returned home.”
The famous experiment in which rats, given a choice of water or morphine solution to drink, became addicted has a second phase I never read about in the popular media. Those addicted rats had been isolated in bare metal cages, but when they returned to comfortable cages with a rich environment and other rats to socialize with, they spontaneously preferred water “even when they were currently addicted. In other words, they ‘quit’ voluntarily.”
Lewis says the disease model does a good job of explaining why some people are more vulnerable to addiction than others – genetics, emotional problems, PTSD are factors – but doesn’t seem to lead to a “cure.” Rather addiction is treated as a chronic disease. But “the disease model probably does more harm than good for most addicts. Yet its benefits for other players are clear.” Rehab is a multi-billion dollar industry in the Western world “with much to gain and much to lose.”
Addicts Do Recover
A model based on choice – including environmental conditions like poverty and social isolation – does a better job of explaining how people become addicted and how they quit. “It should not be surprising, then, if people choose to quit when life circumstances improve, or the… costs of remaining addicted exceed the benefits.” The idea of “self-medication” is related. “Drugging and drinking make you feel better. Until they don’t.” The concept of hitting-bottom fits here, or, as Lewis puts it “when they’ve hit bottom once too often.”
Lewis feels the disease model can actually interfere with breaking free of addiction. In one study “the only pretreatment characteristic that predicted [alcohol] relapse… was ‘the extent to which clients endorsed disease model beliefs before entering treatment.'” He presents data showing the “most addicts eventually recover permanently…[and] think of themselves as free – not cured, not in remission.”
I was interested in his evaluation of Alcoholics Anonymous (and related 12-step programs for other addictions). I have a friend who quit through AA and felt the disease model was vital to staying sober. I have another friend whose father – after years of alcoholic bingeing – found he could stop after one beer. Indeed, Lewis says “epidemiological research shows that many recovered alcoholics are capable of social drinking.” I know my AA friend would never risk it.
Lewis points out AA originally called alcoholism a mental and spiritual “malady,” a combination of sensitivity or allergy to alcohol and “inability to be at peace in the moment.” The disease terminology appeared in AA in 1967 when the American Medical Association termed alcoholism an illness.
Choice Good or Bad News?
Increasingly addicts are forced into treatment programs by courts – “independent of their personal beliefs, which are often dismissed as irrelevant…This policy discourages addicts from finding their own way… and it blocks their access to… alternative resources… compelling data [shows] that most addicts and alcoholics do recover, and that a majority of those – up to three-quarters depending on where you get your statistics – recover without any treatment.”
Whether Lewis’ view strikes you as optimistic or pessimistic will depend on your own experience. Lewis tries to end each chapter on a positive note. I’ll leave it to you to read the stories of five addicts who quit and to review the data Lewis presents.
If the disease model and 12-step programs haven’t worked for someone you care about, Lewis suggests they may still find a way out.
There were only 36 reviews on Amazon when I checked, and seventy-two percent are four or five stars. Those who did not like the book feel Lewis does not present evidence that “his method” works. (I don’t think I’d characterize the book as presenting “a method.” One reviewer even complains that Lewis fails to explain how an addict can use this book.) Other negatives say his data are seriously out of date, especially on genetics, and the “notes” section doesn’t replace a bibliography.