Why Addiction Is Not a Disease
I heard good things from Marc Lewis, and I was curious to read his work on addiction. I was mostly interested in his book Memoirs of an Addicted Brain, but it wasnât available on Audible, so I went with one which is his latest.
I was afraid that I was going to be a bit disappointed. I wasnât particularly interested in arguing against addiction as a disease, as I was already convinced of it, and I didnât want a very in-depth look at the neuroscience of addiction.
Luckily, despite both topics being fundamental in the book, I still greatly enjoyed it and it was a very balanced perspective. The typical argument for addiction as a disease is that the brains of addicts change with their drug use, as the systems that deal with rewards and motivation are reshaped by it. Lewisâ arguments against this were well presented, and itâs the constant theme throughout the book.
There are two studies that are helpful to cast doubt on the traditional model of addiction. One is that 75% of heroin-addicted veterans from the Vietnam War managed to remain sober once returning one. The other is the âratâ parks, where rats have to choose between morphine and water. Isolated rats choose the morphine until they die. This was used to argue for a classical model of addiction. As if the drug itself creates a biological need that overtakes behavior. However, later studies where rats had other rats to interact with, they chose water, even if they were previously addicted to morphine.
I was already familiar with both studies, and I was happy that they were mentioned but werenât in the core of his argument. In fact, they are mentioned very briefly. The core of his thesis is that the supposed brain changes that underlie addiction are, in fact, normal to the circumstances they are in. There is no valid reason to call that a disease.
There was a fair bit of neuroscience, but it never felt too overwhelming. The main premise is that addiction is a habit. A very deep, very entrenched habit, but a habit. It is a normal process that is created in the brain through repeated action and experience. These habits, in turn, modify synaptic networks, and new brain patterns reflect the experience they were created by.
While addiction falls under this habit-creation process, part of what makes it more problematic is that intense and recurring desires increase the speed at which this happens, strengthening the feedback cycle. But the neuroplasticity that underlies the whole process is no different than the regular learning and desire you experience every day. The latter which countless examples are given, such as falling in love or enjoying sports.
What I liked the most about the topic is that it deals with addiction in a deeply personal manner. There is a fair bit of science that explains much of what I covered above, but it is often described within the context of a specific life experience to explain the mechanism of addiction. The book describes five true stories of people who became addicted and managed to quit and lead productive lives. These stories were incredible to read and, for me would have been worth a book in themselves. But Lewis uses these stories as examples of what goes on when people get addicted.
I really appreciated the compassionate perspective around addiction. The disease model is, in large part, so appealing because it seems to be humane towards those who suffer from it. It seems a response to people who think they just have a weak will. This dichotomy is destroyed several times by Lewis, and he makes abundantly clear that just because the brain processes are natural does not mean it is useful to talk about behavior being easily stopped through sheer will. This is clear not only from the stories that are featured in the book but also from the authorâs own experience as an addict.
It was a fantastic book, and despite being familiar with the overall case that is presented, I still learned a lot. Both in terms of the neuroscience of addiction, but perhaps most importantly, how this plays out in the real-world, described by real people who went through hell and managed to come out of it.
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