Marc Lewis – Hibernator's Library

The Biology of Desire, by Marc Lewis, narrated by Don Hagen

Neuroscientist and former addict Marc Lewis writes an engaging study of the biological changes that occur in an addicted brain, complete with personal stories about himself and several addicts that he interviewed. Lewis points out that there are two major models for addiction – the disease model and the choice model – and argues why he believes the disease model has outlived its use and is now harming rather than helping addicts.

The disease model of addiction is highly accepted by clinicians, psychologists, and insurance companies right now. It posits that the more an addict uses a substance, the more his brain changes, and the more he needs the drug. Furthermore, some people have a biological preinclination for addiction – it doesn’t mean that they will become addicts, but the genetic preinclination raises their chance of becoming an addict under the right environmental stimulus. The combination of genetic factors and changes in the brain suggest to clinicians that addiction is a disease. A lot of money, therapy, and medication currently goes into treating addiction as a disease – often successfully.

Lewis argues, though, that changes in the brain and genetic preinclination do-not-a-disease-make. After all, every experience changes your brain – and some events, like falling in love, change your brain in much the same way addiction changes it. Furthermore, much as people have a preinclination for addiction, they also have a preinclination to temperament. For instance, an introverted, agreeable parent is more likely to have an introverted, agreeable child. Despite this heritability, temperament is not considered a disease. So why do we pick-and-choose which heritable brain-changing habits are a disease?

My answer is that addiction is considered a disease whereas in-love and temperament are not considered diseases because in-love and temperament do not generally cause clinically significant impairment in an individual’s ability to function in the workplace and social interactions. And when they do inhibit the individual’s ability to function, then they are considered a disease.

Instead of the disease model, Lewis supports the “choice” model. People choose to abuse substances in the first place, and continue to make that choice. And when they give up the substance abuse, it is generally because they have chosen that now is the right time to give it up.

Lewis spends the great part of this book describing why he feels viewing addiction as a disease is harmful to addicts as well as unhelpful for treatment. When an addict views his problem as a disease, then he might feel helpless to make his situation better. Whereas if he views it as a choice, he recognizes that he has power over this problem. You might notice that this is in stark contrast to the first step of AA in which the addict accepts that he is powerless over his addiction. In fact, in the stories of Lewis’ interviewees, none of them mentioned AA or NA as a helpful tool for stopping their addiction.

Lewis also points out that although medication and therapy generally help the individual to give up alcohol to begin with, there is a very high relapse rate. And that is because although the individual doesn’t want the negative effects of his addiction, he has not yet accepted the choice to give up the drug.

Lewis claims that many people view the choice model and the disease model as mutually exclusive, but he believes that they are not. I would tend to agree with him on this. I don’t see the harm in viewing addiction as a disease – in fact, I think this model would be very helpful to a certain subset of addicts – it provides them a reason to say “this is not my fault, I have a disease, and I need to live as healthy a life as I can in order to not let it ruin my life.” But I also think the choice model is helpful to another subset of addicts – it provides them the ability to say “I have the power to choose not to use. I am not powerless.”

Hi All! My plan is to give a monthly update rather than a weekly (or biweekly in this case) update, but I had some interesting developments in my life over the last couple of weeks and thought it was a good idea to share – since one of the goals of this blog is to decrease stigma of mental illness, I should share my own experiences.

I got a bit burnt out on all the activities I’ve been participating in as described in my September update. Quick summary, I’d been working full time, volunteering 4 hours a week at a crisis hotline, taking a 3 credit Abnormal Psychology class as well as a 7 credit EMT class. When I first signed up for the EMT class, I hadn’t realized it was 7 credits (that wasn’t mentioned on the class description), so I didn’t realize how hard it would be. After a few weeks of it, I got so burnt out that I got really sick – this was last week.

I decided to drop the EMT class, and they were kind enough to let my tuition transfer to next semester. I will NOT sign up for another class – so I’ll be able to focus on the EMT class in January.

Then on Monday, I had a 3 hour anxiety attack. I’m not sure how many of you have had anxiety attacks before, but they aren’t supposed to last that long. It’s sort of like running a marathon for 3 hours. This happened at work, and because I’m the manager, I can’t call my boss and be like: “oh, gotta go home.” I simply had to finish the work. It was an exhausting day.

The next day, I freaked out on my boyfriend for no reason (other than our political differences), and then when I was trying to sleep I felt like a screaming monster was trying to claw its way out of my brain. That’s when I realized I was in a bipolar mixed state.

Bipolar mixed states have characteristics of both depression and mania. They’re very dangerous because they have suicidal ideation mixed with impulsivity, motivation, and energy. Mixed state people are much more likely to commit suicide than a depressed person, because depressed people often lack the energy and impulsivity, motivation, and energy to commit suicide.

Yesterday, I called my psychiatrist but I got stuck in the labyrinthine maze of monsters that is the Park Nicollet phone reception system. One of the monsters even hung up on me, and I had to proceed to “Go” without collecting my $200. By the time I got through to the nurse (an hour later), I was rather worked up. She calmly told me that this is not a crisis line, and I should call Crisis Connection (where, by the way, I volunteer). I practically yelled at her that I didn’t want a crisis hotline, I wanted to talk to my psychiatrist. She made an appointment for me to see her later that afternoon. I also made an emergency appointment with my therapist, who I haven’t seen since March.

In the end, my psychiatrist tweaked my mood stabilizer and gave me a prescription to Klonopin, which is a benzodiazepine – an addictive sedative. I’m a little worried since addiction runs in my family, and when I start getting symptoms of mania (or apparently mixed symptoms) I start craving alcohol, pain meds, and other such things. I’m not much of drinker, and I’m not in the habit of taking unprescribed pain meds, but I crave them all the same. So getting permission to take a benzodiazepine is a little troubling to me. However, I recognize that I need it in situations like those described earlier in my post.

On a happier note, I was able to go to the Nobel Conference at Gustavus Adolphus College on Tuesday and Wednesday. The theme was addiction, and my Abnormal Psychology prof took a bunch of his students. There were 6 speakers and they were all really interesting.

One of the speakers was Marc Lewis, the author of The Biology of Desire, which I just finished. It turns out Marc Lewis is a bit annoying. He kept trying to push his point (that addiction is a choice and not a disease), until Eric Kandel, the 2000 Nobel Prize Laureate in Medicine, told him “it’s either bullshit or science.” Another speaker, Carl Hart, who is big on social justice, tried to break the tension by saying “I didn’t know we could swear at this conference!” And then the next day during Hart’s speech he said “and to quote Dr Kandel, this is bullshit!” It was a pretty amusing conference. Of course, the science was really interesting too, but I plan on writing a review both of the conference and of Biology of Desire, so I’ll stop here.

I’m currently reading or listening to: