The Biology of Desire: Why Addiction Is Not a Disease
“. . . drug use messes up brain wiring, and the mess doesn’t disappear when you quit,” writes Marc Lewis PhD, a neuroscientist and professor of developmental psychology at Radboud University in the Netherlands. This is the basic principle of his latest book, The Biology of Desire: Why Addiction is not a Disease.
In short, he confirms what leading neuroscientists studying addiction have been saying for the past few years: that addiction is at its core a co-optation of the learning functions of the brain. The brain, doing what it’s supposed to do in the learning process, is hijacked or put into overdrive by the repeated behavioral pattern of drug seeking combined with the user’s strong “desire” for the high.
Just as with any learning process, “what fires together, wires together” in the brain, and so this behavioral pattern becomes locked in, overriding normal decision-making functions. To overcome addiction, individuals must find unique, individualized methods to begin a new process of “deep learning” and thereby change brain function in novel, healthier ways.
This book is not an academic work in the normal sense. Although The Biology of Desire explains Dr. Lewis’ theories about addiction recovery and some of his research findings, the piece is not put together like a standard academic book. Instead, Lewis writes about addiction in a general way, specifically focusing on the ways that the definition of addiction that researchers and treatment professionals use dictates how addiction is treated and the ways in which addiction changes both the structure and function of the brain.
Lewis focuses on how the brain is set up to allow for deep learning, and as a deep learning process, to allow for addiction. The author then provides five case studies through which he attempts to illustrate the ways in which the brain is changed at various stages of the addiction and recovery process. Finally, the book culminates with the author bringing together research and case study to inform his theory of addiction as a process of deep learning and his look toward the future of addiction treatment.
Where The Biology of Desire is strongest is in its easy to follow explanation of brain function and the latest neuroscience research, and applying this science to the experience of addicts. Lewis writes:
“Connecting the biology of addiction to the experience of addiction is no simple matter. Neuroscience concepts distil information from hundreds of thousands of experiments, each one conducted on dozens of individuals. . . . Whereas individual experience is just that. It usually involves almost the opposite process: a lot of reflection on singular moments in a singular life. . . . These are radically different kinds of data.”
Lewis pares down the scientific jargon and shares about the brain and its learning processes in clear, easy to understand terms. His diagrams and charts are simple and easy to read, yet are not dumbed-down. He brings together scientific data and individual lived perspective seamlessly.
Lewis also shows great compassion and empathy for addicts. He is exceedingly clear that addiction is not solely something that happens in the brain, but also comes from deep pain or emotional distress. “But addiction is most likely to arise from more specific needs,” he writes. “. . . nestled in personalities with specific wounds, the result of hurtful or disorienting conditions in childhood or adolescence.” Through each of the case studies Lewis presents, his retelling of the addicts’ stories is done with concern and a warm-heartedness that is too often removed from science.
Lewis’ book is weak with regard to two areas: treatment recommendations and lack of clarity about the implications his work could have for addicts seeking treatment.
First, it is obvious that Lewis is a scientist and not an addiction treatment provider. There are myriad treatment options available to addicts, some of them based on the neuroscientific principles Lewis lays out in this book, but few of these treatment options are discussed and the discussion that is present is superficial at best.
Readers of The Biology of Desire would have benefitted tremendously from an additional chapter in which Lewis might have looked at the handful of cutting-edge addiction treatment programs that use a combination of neuroscience-based therapies to rewire the brain coupled with intensive psychotherapy to deal with underlying personal wounds, to treat addiction with outstanding results.
Instead he hopes for better outcomes from community based treatment, like 12 step programs, which have been shown conclusively to have the poorest treatment outcomes when used on their own, without benefit of other supportive resources.
Second, Lewis fails to understand how, at least in the United States, redefining addiction as a problem of learning rather than as a disease would place addiction treatment resources beyond the reach of most addicts in need. Why? If addiction can be classed as a learning disability rather than a medical disorder, medical insurance will not cover treatment. Certainly, one might be able to look at the process that occurs in the brain as one of learning, but the result is brain dysfunction and a host of co-occurring physical and psychological disorders, including but not limited to malnutrition, HIV and hepatitis, depression, anxiety, sepsis, and other very serious and accepted medical disorders.
Yes, the latest neuroscientific research does suggest that addiction occurs because of the way the brain is constructed. And while it may be a learned behavior, it is a process that corrupts and deforms the brain outside the realm of normal function. That is the very definition of a brain disorder.
What’s the solution? As Lewis quite rightly suggests, the best forms of treatment work to rewire the brain in positive ways. There are a handful of treatment centers that are already offering individualized care based on this neural repatterning. Unfortunately, few insurance companies will cover this care because it takes more than 30 days to rewire the brain, and as of now, this treatment remains out of reach for the majority of addicts who are desperately seeking help to recover from their condition.