e-book The Biology of Desire: Why Addiction Is Not a Disease

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But with the rise of industrial societies and their accompanying problem of alienation, the reverse problem has become increasingly common: a complete surrender to narrow, self-fuelling, self-destructive desires. Fleeing from our insecurities, we take refuge in alcohol, drugs, gambling, pornography, romantic love or computer games, etching ever deeper loops of dependence into our brains.

But none of this takes adequate account of the way desire is central to our good works as well as our bad, and how even a wish to extinguish desire is also a desire. A neuroscientist but also an ex-addict himself, Lewis makes the case that addiction is primarily a diverted learning process. We learn by seeking rewards, and then responding to the dopamine signals we get back to seek more of the same. The only difference, of course, is that the feedback loop in drug addiction can more easily become both compulsive and ruinous.

Not only that, but when they have recovered they will have benefitted in the long term from a profound learning experience. Although willing to acknowledge the relative strengths and achievements of medicine in trying to help addicts, he argues that addiction is not helpfully understood as a disease. The chief reason for this is that addicts, in order to recover, need to shift to a bigger motivation for living their lives without addiction. These are bigger questions that Lewis obviously does not see as within his scope.

Lewis sees the need for the addict to take responsibility, but also recognises the full difficulties of doing so.

He also recognises the role of past traumas in producing anxiety that addiction often seeks to allay, but that does not make self-medication a total explanation. His basic account of the brain activity of addiction is that a feedback loop develops between the striatum — the motivating organ in mid-brain that is fired by dopamine — and the dorso-lateral prefrontal cortex, which shapes goals and methods of reaching them. When our goal becomes the relief from underlying anxiety that can be temporarily gained through the object of addiction, and we keep getting the dopamine hit of a goal fulfilled, the neural pathway between the two becomes ever more strengthened and alternative goals gradually become less powerful.

Lewis also explains how the neural pathway also gradually shifts its location as addiction proceeds, so as to become gradually less conscious and more compulsive. The grey matter that provides reflective awareness in the prefrontal cortex decreases, as we descend to increasingly automatic actions dictated by our lower brains.

But Lewis also tracks the process of recovery.

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The brain is still flexible enough to rebuild itself, and more positive goals provide a perspective that enables recovering addicts to re-frame the addiction as a diversion from those goals rather than an all-encompassing need. Rather, they reframe their goals. The practices of meditation and mindfulness can be very helpful in doing this. The relationship of this reframing to the Middle Way should be obvious.

As Lewis said in his recent podcast interview with Barry , he sees the Middle Way as lying between asceticism and hedonism, those two polar opposites in our attitude to desire that are even recognised in the classic Buddhist version of the Middle Way. So far, then, we have a highly informative and inspiring book whose overall intention is obviously very much in harmony with the Middle Way. These limitations involve a lack of intellectual integration between this approach to addiction and related issues of cognitive psychology, a puzzling interpretation of the role of the brain hemispheres, and an apparent residual allegiance to the model of self-control even when he elsewhere emphasises reframing as a better alternative.

However, the concept of ego fatigue is just another way of talking about conflict. You can repress a desire, but if it is still strongly present in the entrenched neural pathways Lewis describes so vividly, it will be back.

The flips of the anorexic-bulimic resemble those of the addict making initial weak and unsuccessful attempts to quit, as also those of the religious convert, the hypocritical moralist, or the rebellious individualist. On one level they may be due to a lack of the glucose required to keep open a new synaptic track when an easier and older one exists as an alternative.

But that by itself would not account for the counter-dependence of opposites in our cognitive construction of the situation. Easier tracks are not necessarily opposite tracks. To account for that we need to pay much more attention to the role of the brain hemispheres than Lewis does, as I will explain below. Lewis acknowledges the different roles of the left pre-frontal cortex in specialising in goals and representations, whilst the right provides new information from the body and senses.

However, he does very little with this, and some of what he does say is puzzling and on his own admission speculative. He notes that the recovery of addicts who generate a wider perspective in their lives seems to produce stronger links between the striatum and the left pre-frontal cortex.

That would indicate that recovering addicts do need strong goals and representations, but that could hardly be enough by itself given the tendency of the over-dominant left pre-frontal cortex to absolutise — forming beliefs that it takes to be certainties. Given the established roles of the two hemispheres, it would seem impossible for an addict to recover without a good input from the right hemisphere integrated with the left. More false certainty would just provide a basis of further repression and conflict, as the rigid certainties of the over-dominant left hemisphere repress alternatives.

Instead, the recovering addict must surely have access to new perspectives that challenge that rigidity and help him or her to re-frame rather than repress the patterns of addiction. These could only possibly come from the right hemisphere, even if this happens indirectly through more adequate integration with the left as well as stronger communication between the left and the striatum. Far from being able to get a wider perspective of their longer-term interests through sole dependence on the left hemisphere, then, recovering addicts will need an active sense of how their experiences at different times are linked.

Such linking can only come from the right hemisphere integrating the otherwise isolated sequential goals and representations of the left. If we recognise the segmented and sequential nature of the over-dominant left hemisphere, that makes it easy to account for inconsistencies in belief in both addicts and dogmatists.

If we understand the repressive nature of absolutising, we can also make sense of the way that beliefs as well as associated desires flip between opposite extremes. When we are absolutising, everything that is not the absolute we identify with is a negation of it.

The Biology of Desire | Understanding Addiction

That is a point that applies to addicts as much as to for example fundamentalists. All other distinctions disperse together with the grey matter that would be needed to make them. However, there is no reason to think that our temporal absolutisations more generally need to necessarily take the form of discounting the future in favour of the present.

But in The Biology of Desire, cognitive neuroscientist and former addict Marc Lewis makes a convincing case that 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. Added to basket.

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The Incredible Unlikeliness of Being. Alice Roberts. The Quantum Universe. Brian Cox.

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Fermat's Last Theorem. Simon Singh. Periodic Tales. Hugh Aldersey-Williams.

Blue Mind. Wallace J. In Search Of Schrodinger's Cat. John Gribbin. David Eagleman. Bad Science. Ben Goldacre. He doesn't want us to go back to a Victorian-era-style "choice model" where addicts are expected just to ward off temptation. He sees a path — very much led by science, Lewis works hard in this book to dispel any notion he's an alternative medicine huckster and also by developmental therapy, where addicts can grow rather than merely be supplied with strict regimes and pills.

We're introduced to our five heroes: a college student addicted to heroin, a meth addict in a broken marriage, a carer who steals drugs, an alcoholic trying to drink away the abuse he suffered at the hands of priests, a bulimic woman who's been tormented by her looks since kindergarten. Each of these protagonists have been through the hospitals and the Anonymous groups but all of them found in the end psychology and development therapy did the trick. Taken alone these stories are deeply touching and at times very dramatic — one of the heroes jumps from a second-storey window to escape a gang of particularly violent dealers — but they work together to establish Lewis' picture of how a disease model fails addicts and how working with addicts to develop their behaviour tends to be the better answer — often returning the brain to a pre-addictive state.

A lot of people will come to Lewis' book with a degree of scepticism — arguably the wisest approach to any work of non-fiction these days — and Lewis knows this. He acknowledges physical addiction's role — think nicotine in cigarettes or comparable substances elsewhere — but rebuts it by asking if addiction is purely physical why are we addicted to gambling or porn or video games?

Are we addicted to adrenalin? Lewis doesn't examine this but he does construct a very scientific argument in this book. Whatever reservations about mindfulness and meditation being a bit New Age the more sceptical reader may have.