Neuroscientist looks at addiction from the brain down
Marc Lewis is a neuroscientist and professor of developmental psychology. Now at Radboud University in the Netherlands, he taught for more than 20 years at the University of Toronto. His book Memoirs of an Addicted Brain: A Neuroscientist Examines His Former Life on Drugs was the first to blend memoir and science in addiction studies. In his new book The Biology of Desire, he explains why the disease model of addiction is wrong and tells the true stories of five people who journeyed into and out of addiction. Q Your new book makes the case that addiction is a habit rather than a disease. Can you explain?
A People have been calling addiction a habit for a long time. We generally think that’s just a colloquial use of the term. Yet neuroscience shows us that the brain is a habit- forming machine. When we learn new modes of behaviour, or discover new and appealing goals, whether it’s a drug, a course in gourmet cooking or a love relationship, we develop mental habits of thought and feeling that attract us to the same goal or substance or activity over and over and over again. We build up patterns of synaptic connections that are self-reinforcing, that become consolidated with time, thus developing a brain state that responds to that particular activity in similar and highly predictable ways. In calling it a habit, I am not meaning to diminish the severity of addiction or ignore the harm it causes, but calling it a disease merely labels it and makes it part of a medical hierarchy with an expert-based treatment system that doesn’t work very well anyway. I think that looking at it as a habit that develops, consolidates and becomes entrenched over time leads to a more realistic understanding of addiction scientifically and better options for treating it effectively.
Q Addiction treatment programs and institutions are a big business in North America. Do you think that these largely abstinence-based programs are effective?
A No, they are often not effective. They result in a revolving door policy of people attending rehab programs again and again and again. I have a friend who runs groups at a variety of rehabs, and when he asks his new group of patients: “How many of you are here for the first time?” there are very few hands going up. Second time? Third time? Hands start to spring up at numbers like seven or eight. Most of his clients are on their 10th or 12th trip to rehab. Most disease-model rehabs, and these are by far the majority, provide drugs which help their clients deal with withdrawal symptoms, but don’t provide any kind of ongoing maintenance program: pharmaceutical, psychotherapeutic or counselling, or a combination of these. Clients leave rehab programs and are very prone to react to cues in their home environments, leading to intense craving — without the support of their institution — and triggering the repetition of their addictive behaviour. These programs can be extremely expensive and are very lucrative for the rehab provider. Some of the high-end luxury residential programs cost more than $100,000 per month. At the other end of the spectrum are state- or province-sponsored rehabs that are poorly run, under-staffed, staffed by people with few or no qualifications, and that’s where many addicts end up because they can’t afford a fraction of the costs of private rehabs.
B.C.-based therapist Michael Pond recently wrote a book called The Couch of Willingness. It describes perfectly how ineffective these lower-end rehab programs — for the most part faith-based 12-step programs — were in helping him treat his own addiction. But private rehabs don’t necessarily have higher success rates. They’re just more comfortable, more livable.
Q Can you explain the role that brain plasticity plays in overcoming addiction?
A The brain falls into synaptic configurations (the web of connections among brain cells) that underscore cognitive conditions that can be quite dysfunctional, whether caused by trauma, learning disability, even strokes or brain injuries or something else. But these are not permanent end states — the brain is incredibly plastic, even mouldable. It’s not elastic like an elastic band — you can’t keep pulling it back and forth and expect it to resume the shape it had before. It’s more like Plasticine. Whatever shape it assumes does not have to be an end state. Norman Doidge makes this point in his excellent book The Brain that Changes Itself. In fact, highly dysfunctional brain patterns can continue to be modified by new learning experiences, mental exercises and even changes in perspective. The disease theory of addiction argues that, because addiction makes synaptic changes in our brain, it must be a disease. Brains do change with addiction, but they also change with falling in love, or learning to play an instrument. Yet people fall out of love and change from one instrument to another. To see the corresponding brain changes as carved in stone makes no sense in our present scientific context. I have talked to hundreds of former addicts, and when they speak about how they overcame addiction, it wasn’t that they bounced back to the state they were at before they became addicts, nor did they learn to live with a set of permanent brain changes — rather that they experienced an ongoing and continuous growth trajectory, a profound change in their thinking and their behaviour, strongly suggesting ongoing brain change.
Q The addicts profiled in your book have all suffered physical, social, or psychological adversity in childhood. What is the connection between childhood adversity and addiction?
A Vancouver physician Gabor Mate has done much research on this topic — he believes that all addiction is an eventual result of early adversity. I wouldn’t go quite that far, but most serious addicts have experienced periods of depression and anxiety in childhood or adolescence, and these conditions rarely go away completely. You obviously want to feel better — and so you experiment with drinking or drugs or overeating and you find that these activities change the way you feel. You find something that works. So, yes, there is definitely a connection between feeling ill at ease in the world, feeling a sense of not belonging, and finding a substance or activity that makes you feel more centred or at peace.
It was like that for me. I became an addict several years after a terrible time at boarding school. I wrote about that experience and its impact on my life as an addict in my last book, Memoirs of an Addicted Brain. Marc Lewis will be speaking at the Djavad Mowafaghian World Art Centre, Room 2555 at the Goldcorp Centre for the Arts, Simon Fraser University, 149 West Hastings St., on Tuesday at 7 p.m. in an event presented by PHS Community Services Society. For more information, visit biology-of-desire.eventbrite.ca.