Marc Lewis Ph.D. – Is drug addiction a disease?
We live in a world where the word addiction has become synonymous with bad behaviour and disease. Whether it’s addiction to gambling, drugs or even food, we are told that a healthy appetite is acceptable but that stepping over that line is unacceptable. However, some taboos should be contended with and developmental neuroscientist Marc Lewis is confronting one of the biggest, drug addiction. He has an alternative theory of what drug addiction is and why it occurs. In his latest book, The Biology of Desire, Marc Lewis Ph.D. argues that drug addiction is not a disease and highlights the power of the brain to reorganize itself through learning, experience, and intentional self-direction.
Please tell us a little about your history and background?
I was a fairly normal kid, raised in the suburbs of Toronto, until I was sent to a boarding school in Massachusetts at the age of fifteen. In the next two years I became depressed, desperate, rebellious, and sneaky, but you would still have found me an optimistic, ebullient person, at least on the outside. Then the family moved to California in 68. I became an undergrad at UC Berkeley, and I found and took every drug I could lay my hands on. Five years later I’d developed a pernicious addiction to opiates, which ended with a couple of convictions back in Canada, years later. As a result, I got thrown out of grad school and became a house painter. A few years after that (age 30) I quit drugs, got back into school, got a Ph.D. and then a job as a professor in developmental psychology and neuroscience. I did that for over twenty years, raised a few kids, and then became interested in exploring addiction as a scientist rather than a user.
In your book, The Biology of Desire: Why Addiction is not a Disease, you argue that addiction is a behavioural problem that requires willpower and motivation to change. Can you tell us about that?
The disease model of addiction is based on findings that there are considerable changes in synaptic structure in areas of the brain responsible for goal seeking, attraction, compulsion, and self-control. I start off by showing that these changes are by no means “chronic,” as insisted on by the medical/psychiatric authorities (e.g. NIDA). They are phases of the neuroplastic change that accompanies learning in general and deep learning in particular. By deep learning, I mean the kind that builds on highly-motivated goal-seeking experiences that are repeated often, like falling in love, becoming a parent, becoming a religious fanatic, or becoming expert in music, politics, and any number of things.
Addicts become expert in drug or alcohol seeking. And experts rely increasingly on automatic behavioral habits, well ingrained over years of practice. I don’t doubt that addiction is dangerous. I’ve seen its devastation in my own life. But I think most of us realize on reflection, that it takes willpower and perspective change, both of which arise from our own strong desire to improve ourselves, to modify deeply learned habits. William James was very clear about that over 100 years ago. In the book, I relate detailed biographies of five addicts whose lives demonstrate the developmental nature of addiction and recovery, and I annotate these stories with simple concepts from neuroscience.
Drugs have a very uncertain position in society. They are tied both to recreational enjoyment and also to a much more nefarious side. What do you think the biggest misconception we have about drugs is?
Recently Carl Hart and Johann Hari have gone a long way toward dislodging some of these misconceptions. They stress that most recreational drug users simply never become addicted. I would add that most of those who do become addicted eventually quit. The stats are easily accessible through the NESARC website and other sources. People seem completely shocked to hear that addiction (for most users) is temporary — not permanent. But recognizing this fact helps brings hope, optimism, and a sense of personal empowerment to addicts everywhere.
What happened to the notorious “war on drugs?” With attitudes now changing quite prominently towards drugs.
You’ve got to read Hari’s “Chasing the Scream” for that one. Marvelous book. In a nutshell, more and more people inside and outside the “addiction community” are recognizing that the war on drugs did a lot more harm than good. Like Prohibition, it simply didn’t work. But the havoc it’s caused — the increase in violent crime and the tens of thousands of users whose lives have been destroyed by time in prison and then carrying around a criminal record — shows the whole enterprise to be wrong-headed, malicious, and ultimately obscene.
I wish more people would recognize that addicts aren’t a different species. They may have made some poor choices, they may be stuck in a behavioural and psychological rut they’ll have to dig themselves out of, but they deserve the same support and respect as any other human being trying to overcome a problem.
