Addiction is not a disease?

NEUROSCIENCE and ADDICTION

Marc Lewis is the neuroscientist who recently stated in an interview with the Globe and Mail that addiction is not a disease, but is, rather, an exaggerated form of learning, an example of very normal brain activity.

Lewis has just written a book (to be released on August 4^th), titled “The Biology of Desire” and which looks at the neuroscience of addiction, mixing personal narratives with scientific data. His interest in addiction sprang from his addiction to opiates when he was in his 20s.

Lewis says that the basis of the disease argument is that addiction corresponds with brain changes – in effect, it hijacks the brain and acts as though it were a pathology or disease process. But, Lewis argues that since the brain is designed to change, all learning changes the brain –– but when you have highly motivated learning, especially something that gets repeated over and over, then the learning curve rises extremely rapidly, and you have a kind of exaggerated learning phenomenon, where the learning is deep and specialized, and blots out other available habits or other available perceptions.

Lewis observes that the brain changes occur at the same time as lived experiences: The moment-to-moment changes of thoughts and feelings are completely yoked to changes and activity in the brain, but it’s almost impossible to tell both stories at the same time, because one is under the skin, in terms of cell firings and electrochemical impulses and stuff, and the other one is in terms of behavior and human values and norms and so forth.

Although the disease model of addiction is definitely the predominant model right now among doctors and psychiatrists, Lewis says that his beliefs are part of a countervailing voice that’s coming out now and saying it’s not a disease. He also says that the disease model is a ridiculously cheap and easy way to try to get addicts off the hook, even though saying it’s a disease, and therefore not the Addict’s fault, is an answer that lacks sophistication.

When asked if he proposes an alternative model for treating addiction, Lewis said that, if addiction is a disease, then doctors should be on the front line. But the reality is, according to Lewis, that all doctors really have going for them are drugs like buprenorphine, which is an opiate, like heroin, and morphine, that can be controlled by doctors, though prescriptions. According to Lewis, buprenorphine relieves withdrawal symptoms and doesn’t get you as high as heroin or morphine. Doctors can also give drugs that counteract the opiates, so you don’t get high no matter how much stuff you take.

Lewis argues that, one way or another, these drugs have a very simplistic effect but are not a deeply meaningful ways of treating the essential problem of addiction. They can relieve withdrawal symptoms, they can put you on maintenance doses, so you remain addicted to an opiate substitute, or they make it so you can’t get high. Lewis wants to take the neuroscientific perspective and change the way we think about treatment.

Lewis calls his approach to treatment Now Appeal where there are immediate rewards available to the addict that drown out future rewards that may be of higher value. His idea is to help people crawl out of the present tense of “I gotta get high tonight, today. Never mind next week, I can’t think about next week.” Lewis believes that addicts lose the narrative of their life and don’t know what it’s like to be a person with a past, a present and future, just a deadly vortex of now

The centre of Now Appeal is this:

1. To highlight an approach to treatment whereby addicts find the motivation to get from ‘now’ to ‘later’.
2. Addicts need to be able to really want to quit, because life is becoming hellish, and that all has to do with the activation of the striatum, that powerful desire centre [of the brain].
3. Addicts need to hook their desire with a sense of story or a sense of future.
4. Addicts need help from other people – whether it’s a therapist, a family member or friend, a support group, it can even be an AA group – because other people can help them hold the pieces in place, so they can get from ‘now’ to ‘later’.

Speaking only for myself, I do not have particular reason to argue with the position Lewis has taken because I agree that it would be a really bad idea to turn over the responsibility for treatment to doctors and the medications they prescribe.

Another reason I have no argument with the approach that Lewis is advocating is because the “4 Steps” he has listed are very much in accordance with AA’s approach to sobriety. Nor does his approach contradict our Dynamic Discovery approach to dealing with addictions.

At Dynamic Discovery, we have addiction services available with our addictions counsellors offering a professional and confidential service. Are you ready to begin taking the positive steps forward down the road to recovery? Contact us for more information!