The Biology of Desire: Why Addiction Is Not a Disease

226 Pages·2015·1.48 MB·English

by  Marc Lewis PhD

THE BIOLOGY OF DESIRE

Copyright © 2015 by Marc Lewis Published in the United States by PublicAffairs™, A Member of the Perseus Books Group
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Book design by Jeff Williams
A CIP catalog record is available for this book from the Library of Congress.
ISBN 978-1-61039-438-3 (e-book)
Library of Congress Control Number: 2015940383
First Edition
10 9 8 7 6 5 4 3 2 1
For the members of my blog community, who have generously shared their
experiences and insights, and for the five who trusted me to tell their stories here
CONTENTS
I
NTRODUCTION
Chapter One Defining Addiction: A Battleground of Opinions
Chapter Two A Brain Designed for Addiction
Chapter Three When Craving Comes to Power: Natalie’s Story
Chapter Four The Tunnel of Attention: Brian’s Romance with Meth
Chapter Five Donna’s Secret Identity
Chapter Six Johnny Needs a Drink
Chapter Seven Nothing for Alice: The Double-Edged Sword of Self-
Control
Chapter Eight Biology, Biography, and Addiction
Chapter Nine Developing Beyond Addiction
A
CKNOWLEDGEMENTS
N
OTES
I
NDEX
INTRODUCTION
Public attention has been riveted by the harm addicts cause themselves and those
around them, more in the last few years than ever before. And the way we view
addiction is changing, moulting, and perhaps advancing at the same time. We’ve
begun to separate our ideas about addiction from assumptions about moral
failings. We’re less likely to dismiss addicts as simply indulgent, spineless,
lacking in willpower. It becomes harder to relegate addiction to the down-and-
outers, the gaunt-faced youths who shuffle toward our cars at traffic lights. We
see that addiction can spring up in anyone’s backyard. It attacks our politicians,
our entertainers, our relatives, and often ourselves. It’s become ubiquitous,
expectable, like air pollution and cancer.
To explain addiction seems more important than ever before. And the first
explanation that occurs to most people is that addiction is a disease. What else
but a disease could strike anyone at any time, robbing them of their well-being,
their self-control, and even their lives? Many esteemed public health
organizations and doctors call it a disease. Rehabs, addiction counsellors, and
twelve-step fellowships call it a disease. Research over the last twenty years has
found indisputable evidence for changes in brain structure and function that
parallel substance abuse. And genetic studies reveal heritable traits that
predispose people to addiction. All this seems to clinch the definition of
addiction as a disease—a physical disease. And that gives us hope, or at least
forbearance, because the notion is sensible, comforting in its own way, and part
of our shared reality. If addiction is a disease, then it should have a cause, a time
course, and possibly a cure, or at least agreed-on methods of treatment. Which
means we can hand it over to the professionals and follow their instructions.
But is addiction really a disease?
This book makes the case that it isn’t. Addiction results, rather, from the
motivated repetition of the same thoughts and behaviours until they become
habitual. Thus, addiction develops—it’s learned—but it’s learned more deeply
and often more quickly than most other habits, due to a narrowing tunnel of
attention and attraction. A close look at the brain highlights the role of desire in
this process. The neural circuitry of desire governs anticipation, focused
attention, and behaviour. So the most attractive goals will be pursued repeatedly,
while other goals lose their appeal, and that repetition (rather than the drugs,
booze, or gambling) will change the brain’s wiring. As with other developing
habits, this process is grounded in a neurochemical feedback loop that’s present
in all normal brains. But it cycles more persistently because of the frequent
recurrence of desire and the shrinking range of what is desired. Addiction arises
from the same feelings that bind lovers to each other and children to their
parents. And it builds on the same cognitive mechanisms that get us to value
short-term gains over long-term benefits. Addiction is unquestionably
destructive, yet it is also uncannily normal: an inevitable feature of the basic
human design. That’s what makes it so difficult to grasp—socially,
scientifically, and clinically.
I believe that the disease idea is wrong, and that its wrongness is
compounded by a biased view of the neural data—and by doctors’ and scientists’
habit of ignoring the personal. It’s an idea that can be replaced, not by shunning
the biology of addiction but by examining it more closely, and then connecting it
back to lived experience. Medical researchers are correct that the brain changes
with addiction. But the way it changes has to do with learning and development
—not disease. Addiction can therefore be seen as a developmental cascade, often
foreshadowed by difficulties in childhood, always boosted by the narrowing of
perspective with recurrent cycles of acquisition and loss. Like other
developmental outcomes, addiction isn’t easy to reverse, because it rides on the
restructuring of the brain. Like other developmental outcomes, it arises from
neural plasticity, but its net effect is a reduction of further plasticity, at least for a
while. Addiction is a habit, which, like many other habits, gets entrenched
through a decrease in self-control. Addiction is definitely bad news for the addict
and all those within range. But the severe consequences of addiction don’t make
it a disease, any more than the consequences of violence make violence a
disease, or the consequences of racism make racism a disease, or the folly of
loving thy neighbour’s wife makes infidelity a disease. What they make it is a
very bad habit.
Although this book uses scientific findings to build its case, it works
through the testimony of ordinary people. I relate detailed biographical
narratives of five very different people, each struggling with addiction, as the
scaffolding on which brain science is introduced and interpreted. I have rendered
these narratives in a literary style, including stream of consciousness and
dialogue, but they are factually accurate, except for the use of pseudonyms and
the inexact wording of some of the dialogue. Through these stories, I show what
it’s like and how it feels when addiction takes hold, while explaining the neural
changes underlying it. There’s no doubt that these changes mark a difficult
passage in personality development. But I conclude each chapter on a positive
note, following my contributors through their addictions to their growth beyond
it—a phase often termed “recovery.” And I provide the neuroscientific facts and
concepts to help us understand how they get there. The many addicts who end up
quitting do so uniquely and inventively, through effort and insight. Thus quitting
is best seen as further development, not “recovery” from a disease.
I’m a neuroscientist and a professor. It’s my job to teach students whatever I
know about the brain. I’ve taught and done research on emotional development
and the brain for most of my career. But after my first decade of lecturing, I
began to sound stodgy and dull, even to myself. What was I missing? The brain
is the foundation of our needs, our desires, our joy and suffering, our darkest
moments and our capacity to overcome them. Why was it coming across as an
anatomical jigsaw puzzle, a blueprint for a circuit board, a thicket of labels,
boxes, and arrows? How could I convey the gut-wrenching reality of the brain as
a motivational furnace? Even in graduate courses, students met my efforts with
glassy stares and furious note taking. Look up! I wanted to shout. Look up from
your notes and feel what your brain is doing. You can get this directly. Not from
your notes. Just introspect a bit and you’ll discover that your brain is busily
extending and revising a landscape of flitting thoughts, shocking associations,
and childish impulses. It’s not just an organ of rationality, as you’ve no doubt
been taught; it’s also the biological engine of our striking irrationality—it has a
dark side. How does that work?
And how do I get it across?
About six or seven years ago I began to talk more candidly about my own
messy emotions. I culled examples from my past, exposing the dark side of my
own brain. That got their attention. Especially when I revealed that I’d been a
drug addict through most of my twenties—something I’d locked away from
public scrutiny for nearly thirty years. Professors aren’t supposed to be drug
addicts, past, present, or future. This was interesting. At around the same time, I
began riffling through the journals I’d kept from my late teens to mid-thirties. I
relived hundreds of traumatic, horrific, and often baffling experiences of getting
high and getting lost. I began to read and think about the brain processes
underlying addiction, and I began the book I hoped would put it all together: my
previous book, Memoirs of an Addicted Brain.