The Biology of Desire: Why Addiction is not a Disease

Marc Lewis, “The Biology of Desire: Why Addiction is not a Disease,” Public Affairs, 2015, 215 pp.

Another very tough book to read but the title intrigued me as it states something I have always believed.  However, this belief needed some science behind it and this controversial book provides that.

Contrary to the theme of this book, the psychiatric establishment in the Western world has determined that addiction is a brain disease, an incurable illness, as opposed to a moral weakness.  This determination that addiction is a disease has, in turn, directed how addiction is researched and treated.  But developmental neuroscientist author of this book, Marc Lewis, argues compellingly that addiction is not a disease. Addiction, whether to drugs, alcohol, gambling, food, sex, or cigarettes, is rather a developmental learning process resulting from the normal functioning of the human brain.  Addiction is about wanting, not liking—desire not pleasure.  The case to show how compulsion in the brain occurs is developed through stories of five addicts, interpreted in the light of state-of-the-art neuroscientific knowledge.  Lewis reveals how addiction is an unfortunate twist of fate for a brain doing what it’s designed to do: seek pleasure and relief in a world that’s not cooperating. 

The biology of desire not only helps us understand addiction, it helps us understand why addiction is not a disease.  Why it is, rather, an unfortunate outcome of a normal neural mechanism that evolved because it was useful. (Pg. 176).

Author Dr. Marc Lewis is a developmental neuroscientist and professor of human development and applied psychology at Radboud University in the Netherlands, and professor emeritus at the University of Toronto. He has more than fifty journal publications in neuroscience and developmental psychology; served as coeditor of Emotion, Development, and Self-Organization: Dynamic Systems Approaches to Emotional Development, and is the author of the critically acclaimed book Memoirs of an Addicted Brain

My Notes:

Pg. x:  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 behaviors 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 behavior.  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.  Addiction is unquestionably destructive, yet it is also uncannily normal: an inevitable feature of the basic human design. 

Pg. 6:  According to the National Institute on Drug Abuse (NIDA—a component of NIH), ‘Addiction is defined as a chronic, relapsing brain disease that is characterized by compulsive drug seeking and use, despite harmful consequences.’ 

Pg. 10:  In a statistically rigorous study it was found that the only pretreatment characteristic that predicted relapse, six months after concluding outpatient treatment for alcohol dependence, was ‘the extent to which clients endorsed disease model beliefs before entering treatment.’

Pg. 18:  Drug and alcohol treatment and rehab represents a multibillion-dollar industry in the Western world, and those treatments and rehab depend on the disease model of addiction.

Pg. 21:  According to some experts, the best evidence against the disease model comes from the study of heroin-addicted veterans of the Vietnam War, about 75 percent of whom kicked the habit once they returned home.

Pg. 33:  People have referred to addiction as a habit throughout recent history.  That’s just what it is.  It’s a nasty, often relentless habit.  A serious habit.  What makes it so enduring and difficult to change are three things.  First, it’s a habit of thinking and feeling—a mental habit—not just a behavioral habit.  Second, the feeling part of addiction always includes the feeling of desire, which is of course the theme of this book.   And third, it’s a habit that becomes compulsive.  The brain is built to make any action, repeated enough times, into a compulsion.  But the emotional heart of addiction—in a word, desire—makes compulsion inevitable, because unslaked desire is the springboard to repetition, and repetition is the key to compulsion.

Pg. 174:  Desire deserves a lot of respect, as does the neural terrain bequeathed to it by evolution.  Think about a forkful of pasta approaching your mouth.  Notice where your attention is directed while you are eating.  While the food is approaching your mouth at least some of your attention is focused on the food.  For now, attention is linked with the goal of getting the food where it’s going.  And you are feeling desire, at least at some level.  If you were not, there would be no point in eating another bite.  Again, desire and attention converge into one beam.  But as soon as the food is in your mouth, your attention goes elsewhere: back to the conversation or to the book you’re reading.  The amount of attention you pay to the taste of that mouthful (especially after the first one) is a drop in the bucket compared to the amount you paid to getting it there.  The evolutionary requirement to focus on pleasure is almost nil.  Once the food is in your mouth, there’s really nothing more you have to do to improve your odds of survival and procreation.  But the evolutionary requirement of getting the food to your mouth, as driven by desire, is immeasurable. 

Pg. 178:  Personality development is really nothing more than the laying down of habits for getting along in the world: habits of attraction, habits of self-regulation, habits for easing emotional concerns, habits for avoiding the rough edges of our lives.  So we can view addiction as a branch of personality development growing out of the residue of unmet needs and failed attempts.  Uncontained anxiety and depression push us to find new sources of relief.  Low self-esteem sensitizes us to opportunities for feeling masterful.  But once addiction becomes the main act, our inadequate resources for self-regulation have to tackle the most challenging negative emotion—craving—which is generated by the addiction itself.  The addiction then becomes the unmet need that overshadows all the others, continuing to build its own callused shell.  Until it’s necessary to find a radically different means of self-regulation.