Why Addiction is Not a Disease, According to Dr. Marc Lewis

A neuroscientist disputes the status quo, calling us all to rethink how we view addiction.

These MRI scans reveal the differences in brain activity in individuals who suffer from addiction versus those who don’t.

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As I looked down at my prepared questions, thinking they were juvenile or topical or pathetic, to ask Dr. Marc Lewis about his new book, The Biology of Desire: Why Addiction is Not a Disease, he stopped me and said, “Before we get started, do you mind if I ask what kind of drugs you did?” Without missing a beat I said, “It began with pharmaceutical opiates.” He paused for a moment and smiled, “Those are some pretty attractive drugs.”

I knew at that moment I was speaking with a neuroscientist who not only understood the brain’s matter—its molecules, membranes, blood, and electricity—but it was clear to me that he also understood the person in which the brain is embodied. Where most neuroscientists dismiss one’s inner-life as fuzzy and immeasurable, Lewis does not. He’s totally interested and fascinated by the lived experience of drug users.

Which is why I found myself enjoying both him and our talk, especially after my nerves quieted and the 8am coffee began to wake me up—or caused my pituitary gland to secrete hormones that in turn caused my adrenal glands to produce a bit more adrenaline, thus honing my attention. See, I can sound neuroscience-y, too.

Though Lewis is busy teaching in the Netherlands, the two of us found time to connect and below we discuss his brilliantly penned Oliver Sacks-like case studies, his argument against the disease theory of addiction, and the importance of goals and time, of humans and their stories.

You write that classifying addiction as a chronic, relapsing brain disease can be harmful. But many argue this takes stigma off the user, whereas the “addiction is a choice” camp may put unnecessary blame on the user. So why is the disease diagnosis also harmful?

There is the assumption, which Dr. Nora Volkow continues to pound in, that we need to label addiction as a disease in order to remove the shame and guilt and self-remorse from it. I don’t think that is necessarily true. We can deal with remorse and shame in other ways. I also think a little bit of shame can be excellent motivation, and getting rid of it entirely is not necessarily a good idea at all.

The disease label often leads to a sense of fatalism: “I’ve got a disease, what can I do? I need to go get help and if I can’t get better it’s because I have a disease…not because of something I’m doing wrong.”

A lot of people who are in the addiction field feel that empowerment, a certain amount of self-discipline, and taking oneself in hand are extremely valuable measures and perhaps the only way to get through it.

I also think that the “disease vs. choice” argument creates a false dichotomy. Choice is not independent of the brain, naturally, so a neuroscience view does not support one or the other. And choice is far from logical in most human affairs. Addiction may not be a disease or a free choice. (Click to Article)

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