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The question isn't why some people become addicts, but why we all don't Add to ...

What causes addiction? That's always a big question. Dr. Lewis traces his own to anti-Semitism at exclusive Tabor Academy, a Massachusetts boarding school where he was sent against his wishes by his parents. They were ambitious Russian Canadians in Willowdale, Ont.: his father arrived in Canada and retrained as a doctor. (He later diagnosed one of his son's three bouts of hepatitis, and prescribed complete rest and no recreational drugs. “So what I did was take two gigantic capsules of organic mescaline and climb to the top of the Berkeley Hills.”)

“I think my parents were idiots in a way,” Dr. Lewis says. “They weren't evil, they just made a big mistake of letting me go to that school. My mother was dissatisfied in the marriage, and I think in some ways she wanted to kind of push me along some path that would be exciting and special and unique.”

He's hardly alone in blaming his parents. Thomas de Quincey, whose Confessions of an English Opium-Eater was published in 1821 (Dr. Lewis claims not to have read it), was left in the care of four guardians when he was 7 after his father died. His mother, meanwhile, was reported to be “deficient in the fine sympathy.”

It turns out that parental neglect is a factor worth considering. The latest neuroscience suggests the brains of children and adolescents are particularly susceptible to deep patterning.

Dr. Lewis's point, however, is not blame, but that human susceptibility to addiction feeds on a hunger for inclusion. Mother's milk, after all, contains opioids, which produce feelings of warmth and safety in the brain and counteract impulses from the amygdala that create anxiety and loneliness. Opioids evolved over the course of 150 million years, probably as means of pain relief. “Perhaps a sense of relief is the main ingredient in the mammalian formula for feeling good,” Dr. Lewis posits. The late Hunter S. Thompson – no stranger to addiction – quoted an unnamed poet to much the same effect in the epigraph to his own faceoff with freak-outs, Fear and Loathing in Las Vegas: “All my life my heart has sought a thing I cannot name.” That is the motto of the drug adventurer. They don't call heroin “mother” for nothing.

In the ongoing battle between the disease model of addiction (addicts are born, not made) and the hard-line choice model (addiction is a decision), Dr. Lewis the neuroscientist is firmly in between. “It's a false dichotomy,” he insists. “The choice people say, hey, … we don't need to understand the physiology of this stuff, because everybody's brain is the same, and some people become addicts and some don't. And that's bullshit. It is about the brain – about hijacking certain brain mechanisms and a really powerful synaptic network that keeps reinforcing itself.”

On the other hand, he says, “addiction is not a disease like hepatitis or diabetes or cancer. Brains are always changing their learning, and addicts just have a supercharged form of learning.” It can therefore be unlearned.

“I've been a developmental psychologist for many years now,” Dr. Lewis says. “And I don't think anyone comes out the way they are – they become the way they are. And you can think of that in terms of the gradual shaping of thought through experience, or you can think of it at the brain level, in terms of synaptic wiring, and the formation of stable synaptic networks in the brain. It's the same thing, really. Mind you, there's a lot of temperament that goes into it, so the initial set of constraints can be pretty powerful. By the time you're in your 20s, you are who you are.”

Even so, Dr. Lewis kicked his own addictions. He finally learned to hear his cravings as just one more voice in his head, competing for attention.

The first step, he insists, was ending his first marriage, which was intertwined with his addiction: He used drugs, she abused him, he needed to use again, ad nauseam. His ex-wife is sharply depicted in the book as a bottomless pit of emotional need. (She once refused to let him attend a four-week drug treatment program because it would have left her on her own). Her emotional-blackmail techniques included lying down in front of his car as he tried to leave her.

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