Marc Lewis says addicts, who are preoccupied with getting their fix the moment they want it, need ‘strong motivation to get from now to later.’Duncan de Fey
Marc Lewis spends a lot of his time thinking about addiction. He has good reason to: In his 20s he struggled with his own addiction to opiates. He was eventually able to quit, and began researching addiction and neuroscience. Mr. Lewis became a professor of developmental psychology at the University of Toronto in 1989, and moved to Radboud University in the Netherlands in 2010. His new book, The Biology of Desire: Why Addiction is Not a Disease, looks at the neuroscience of addiction, mixing personal narratives with scientific data. The book will be released in Canada on Aug. 4.
You argue addiction is not a disease, but an example of very normal brain activity. What do you mean?
[It's] an exaggerated form of learning. Let's put it that way.
People in neuroscience agree that addiction corresponds with brain changes, and that's the basis of the disease argument: That addiction changes the brain, or hijacks the brain, as they say. As though it were a pathology or disease process. Whereas I argue that all learning changes – the brain is designed to change – but when you have highly motivated learning, especially something that gets repeated over and over, then the learning curve rises extremely rapidly, and you have a kind of exaggerated learning phenomenon, where the learning is deep and specialized, and blots out other available habits or other available perceptions.
You chose to mix hard scientific data with these anecdotal stories. How come?
I love that way of writing. It seems to me so amazing that brain changes are going on at the same time as lived experiences: The moment-to-moment changes of thoughts and feelings are completely yoked to changes and activity in your brain, but it's almost impossible to tell both stories at the same time, because one is under the skin, in terms of cell firings and electrochemical impulses and stuff, and the other one is in terms of behavior and human values and norms and so forth. It's a nice way to make science accessible and compelling for non-scientists because this is about people. This is about real people that you can empathize with.
How controversial is your idea among your peers?
The disease model of addiction is definitely the predominant model right now, certainly among doctors and psychiatrists.
But there is a countervailing voice that's coming out now. People like me – I'm not the only one – are saying, no it's not a disease, and that's a ridiculously cheap and easy way to box it and wrap it, and it's also a way to try to get addicts off the hook – not that addicts need to be tortured any more than they already are. But just to say it's a disease, it's not their fault, is probably not a very sophisticated answer to that question.
But it's definitely an underdog position, and I have been and I will get a fair bit of flak for it.
Do you propose an alternative model for treating addiction?
If addiction is a disease, then you should have doctors at the front line. But all doctors really have going for them are drugs like buprenorphine: It's an opiate, so it's [like] heroin, morphine and all the other things people get addicted to, but it can be prescribed by doctors, it can be controlled. It doesn't get you as high, it relieves withdrawal symptoms. Or they give drugs that counteract the opiates, so you don't get high no matter how much stuff you take.
One way or another, these drugs have a very simplistic effect. They can relieve withdrawal symptoms, they can put you on maintenance doses, so you remain addicted to an opiate substitute, or they make it so you can't get high. Those all have problems; I don't think these are deeply meaningful ways of treating the essential problem of addiction.
I try to take the neuroscientific perspective and say, what are the real lessons here that are going to change the way we think about treatment?
One of the main factors is what I call Now Appeal: When there are strongly attractive rewards available immediately [to a person], they drown out future rewards that may be of higher value. So I take that idea and I say what we need to do is help people crawl out of this ditch – of this present tense 'I gotta get high tonight, today. Never mind next week, I can't think about next week.' Addicts lose the narrative of their own life. They don't really know what it's like to be a person with a past, a present and a future. It's just this vortex of now. And that's deadly. That's the centre of what I'm trying to highlight for approaches to treatment.
Addicts need strong motivation to get from now to later. They need to be able to really want to quit, because life is becoming hellish, and that all has to do with the activation of the striatum, that powerful desire centre [of the brain]. But you need to hook that desire with a sense of story, or a sense of future, and for that you need help from other people, very often – whether it's a therapist, a family member or friend, a support group, it can even be an AA group. Other people that help you hold the pieces in place, so you can get from now to later.
This interview has been condensed and edited.