The Biology of Desire: Why Addiction Is Not a Disease
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The psychiatric establishment and rehab industry in the Western world have branded addiction a brain disease, based on evidence that brains change with drug use. But in The Biology of Desire, cognitive neuroscientist and former addict Marc Lewis makes a convincing case that addiction is not a disease, and shows why the disease model has become an obstacle to healing.
Lewis reveals addiction as an unintended consequence of the brain doing what it's supposed to do-seek pleasure and relief-in a world that's not cooperating. Brains are designed to restructure themselves with normal learning and development, but this process is accelerated in addiction when highly attractive rewards are pursued repeatedly. Lewis shows why treatment based on the disease model so often fails, and how treatment can be retooled to achieve lasting recovery, given the realities of brain plasticity. Combining intimate human stories with clearly rendered scientific explanation, The Biology of Desire is enlightening and optimistic reading for anyone who has wrestled with addiction either personally or professionally.
much of their energy came from anxiety, anxiety about just being okay. By now, heroin was both the cause of that anxiety and its only relief. A sense of doom settled over her, a mental and neural pattern that had grown in fits and starts but now oppressed her all day long. She held the hurt and fear inside her while at the restaurant, and then, when she got home, she shot herself up, and those feelings receded like a retreating army, gathering, retrenching, somewhere out of range. For now. Six
particularly liked the rituals and the dogma of NA, but he saw that it was helping him. Here in this gathering he didn’t have to pretend to be something he wasn’t. He was accepted as the tortured person he had truly become. That was soothing to him. It relieved his loneliness. He also started to accept that Vera was long gone. And because his need of her and his desire for meth were so intertwined, it seemed they could be laid in the same grave, put to rest at the same time. For the next four
first one. The next would go down a little more slowly. The call of the alcohol was so strong that he would go to the fridge immediately on waking even if he had to pee. He couldn’t wait. He would pour his drink, take a slug, and then carry it with him to the bathroom. The glass had to be in his hand from the first minute of consciousness to the last. But that was a span of only four hours. Johnny is now in his late sixties. I plied him with questions about this period of his life. I’ve heard
Raw inhibition and suppression (bequeathed by more ventral regions of the PFC) are all they can come up with. In other words, to resist the dictatorial commands of compulsion, broadcast from the dorsal striatum, addicts are forced to rely on control strategies that are essentially childish. I won’t do it! I won’t! I won’t even think about it! (Or in the famous words of the War on Drugs: Just say no.) In fact, this is the worst possible recipe for self-control, because it actually hastens ego
motivation and, 92 dopamine and, 6 striatum and, 55–56 grey matter volume, 137, 188, 189 group therapy, 153–154 See also community-based rehabilitation; community support groups; specific organizations guilt, 9 Habit formation abstinence as, 68 addiction and, 37–38 anxiety and, 33–36 brain and, 41–42, 43–45, 44 (fig.), 93 change and stability and, 31–32 choice and, 138 cognitive aspects, 173 depression and, 35–36 desire and, 35 development of, 35–36 disease model and, 11–12, 37,