Tuesday, 25 August 2015

Addiction - NOT a "Disease"

     “But is addiction really a disease? 
     This book makes the case that it isn’t. Addiction results, rather, from the motivated repetition of the same thoughts and behaviours until they become habitual. Thus, addiction develops – it’s learned – but it’s learned more deeply and often more quickly than most other habits, due to a narrowing tunnel of attention and attraction. A close look at the brain highlights the role of desire in this process. The neural circuitry of desire governs anticipation, focused attention, and behavior. So the most attractive goals will be pursued repeatedly, while other goals lose their appeal, and that repetition (rather than the drugs, booze, or gambling) will change the brain’s wiring. As with other developing habits, this process is grounded in a neurochemical feedback loop that’s present in all normal brains. But it cycles more persistently because of the frequent recurrence of desire and the shrinking range of what is desired. Addiction arises from the same feelings that bind lovers to each other and children to their parents. And it builds on the same cognitive mechanisms that get us to value short-term gains over long-term benefits. Addiction is unquestionably destructive, yet it is also uncannily normal: an inevitable feature of the basic human design. That’s what makes it so difficult to grasp – socially, scientifically, and clinically. 
     I believe that the disease idea is wrong, and that its wrongness is compounded by a biased view of the neural data – and by doctors’ and scientists’ habit of ignoring the personal. It’s and idea that can be replaced, not by shunning the biology of addiction but by examining it more closely, and then connecting it back to lived experience. Medical researchers are correct that the brain changes with addiction. But the way it changes has to do with learning and development – not disease. Addiction can therefore be seen as a developmental cascade, often foreshadowed by difficulties in childhood, always boosted by the narrowing of perspective with recurrent cycles of acquisition and loss. Like other developmental outcomes, addiction isn’t easy to reverse, because it rides on the restructuring of the brain. Like other developmental outcomes, it arises from neural plasticity, but its net effect is a reduction of further plasticity, at least for a while. Addiction is a habit, which, like many other habits, gets entrenched through a decrease in self-control. Addiction is definitely bad news for the addict and all those within range. But the severe consequences of addiction don’t make it a disease, any more than the consequences of violence make violence a disease, or the consequences of racism make racism a disease, or the folly of loving thy neighbour’s wife make infidelity a disease. What they make it is a very bad habit. 
     There’s no doubt that these changes [addiction] mark a difficult passage in personality development. … The many addicts who end up quitting do so uniquely and inventively, through effort and insight. Thus quitting is best seen as further development, not ‘recovery’ from a disease.”

       Marc Lewis. “The Biology of Desire. Why Addiction is Not a Disease.” Doubleday Canada, 2015.  

     See Gerald May's surprisingly similar (1988) perspective, based on 25 years experience as a psychiatrist specializing in addictions: http://healthyhealers.blogspot.ca/2013/11/self-defeating-behaviours-repression.html

     See also "Mechanism Equals Ultimate Cause???": http://healthyhealers.blogspot.ca/2014/03/mechanism-equals-cause.html

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