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Author Topic: Marc Lewis: the neuroscientist who believes addiction is not a disease  (Read 8230 times)

Offline Chip (OP)

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source: http://www.theguardian.com/culture/2015/aug/30/marc-lewis-the-neuroscientist-who-believes-addiction-is-not-a-disease?CMP=share_btn_fb

Marc Lewis: the neuroscientist who believes addiction is not a disease


‘The whole campaign to see addiction as a disease is that it works against people’s sense of empowerment,’ says Marc Lewis. Photograph: Tomas van Houtryve/AP

For decades the medical profession has largely treated addiction as as a chronic brain disease. The US government’s National Institute on Drug Abuse characterises addicts as compulsive drug seekers and users who continue taking drugs despite harmful and unwanted consequences. “It is considered a brain disease,” the institute says, “because drugs change the brain; they change its structure and how it works.”

'No one starts with a needle in their arm': a police chief fights drugs with empathy

Dr Marc Lewis, a developmental neuroscientist – perhaps most famous for detailing his own years of drug addiction and abuse in Memoirs of an Addicted Brain – strongly refutes this conventional disease model of addiction. His new book, The Biology of Desire: Why Addiction is not a Disease, argues that considering addiction as a disease is not only wrong, but also harmful. Rather, he argues, addiction is a behavioural problem that requires willpower and motivation to change.

Lewis’s theory has divided the medical profession and those suffering from addiction. He has been lauded by some for putting the theories challenging the disease model together into one book; others have labelled his ideas dangerous, and him a zealot.

Guardian Australia sat down with Lewis before his appearance at Melbourne writers festival on Sunday and the festival of dangerous ideas in Sydney to talk about the controversy, as well as his theories on how addiction can be treated and overcome.

Through your years as an addict, were you questioning the idea that addiction was a disease you were suffering from? Or is this book purely a result of your later studies and expertise in this area?

Well my training was as a developmental psychologist, so I studied child development, cognitive development, emotional development, and personal development. So I really had a strong developmental framework for thinking about all human psychological phenomena.

When I started thinking about addiction in my first book, it was more or less descriptive. So, ‘This is what happens to your brain when you become addicted,’ and, ‘This is what drugs do to your brain.’ But in this latest book, I wanted to really try to explain addiction, and it just came crashing down that this was a developmental phenomenon. You grow into addiction. It takes place in a sequence or a progression through repeated trials, through repeated exposure, repeated actions, and through practice.

So it wasn’t until you started writing about what addiction is that you really began to think describing it as a disease didn’t make sense to you?

When I was doing drugs, I wasn’t thinking about it in any kind of analytical way, well except, you know, trying to analyse, ‘Why the hell am I doing this to myself?’ But no, I think in writing The Biology of Desire … put it this way. It never occurred to me that addiction was anything other than a developmental phenomenon. The whole idea that addiction is a disease never made sense to me either personally, scientifically, nor through my discourse with other people who are addicted.

Have people been supportive of your arguments that addiction is a behavioural problem, but not a medical one?

It’s been mixed. There’s certainly been negativity. I just had a review in the Washington Post where I was called a “zealot”.

But what really moves me is the addicts who get in touch and say, ‘Don’t take this away from me. If you take away the disease label, then basically I won’t be able to get better, if you don’t let me understand myself as having a disease.’ It’s a very strange argument, to have to think of yourself as having a disease because that’s the only way you can live with yourself and deal with the addiction. And then I feel badly, because I don’t want to harm these people or take away something that they need conceptually or motivationally.

There is this idea that the addiction label is the only thing that is going to save them and stop them from being blamed and denigrated as addicts by society. They feel that if it is a disease, they don’t have to feel that burden or shame, because it’s not their fault. It’s hard to pull the rug out from under that without causing some upset.

Is there anyone for whom addiction is a disease? Are there a small portion of people who are unable to stop taking these drugs, who are wired to be reliant no matter what kind of treatments or motivation they have? Or do you believe that for anyone, addiction should not be labelled a disease?

That’s a really good question. I guess that’s why I’ve been called a zealot in the last day or so. I guess there is a point where the devastation of addiction, combined with the situation of people’s lives – whether through poverty or crime and social isolation – and when those factors hook up they get really hard to stop, really, really hard to stop.

I was in Vancouver a couple of weeks ago at a supervised injecting room, so these were the most down and out people, really long-term street people. Most of them had grown up in foster homes, they had no property, no money. They didn’t connect with the world like most normal people, they lived on the street and their whole lives were organised around getting the next fix.

Given the way their lives are structured I think its very, very hard for them to stop. Does that make it a disease? Well, no, I don’t think it does. I think that makes it a social problem that’s terribly entrenched. It has to do with dislocation, alientation, poverty and all these sort of factors and a lack of care by the larger society for people who are suffering. When you put all those factors on the table, then you don’t have to use the disease label to explain why some people can get really deeply stuck in addiction.

OK, but there are also high-functioning, middle-class and wealthy people with jobs and social support who would describe themselves as addicts, and for whom those social factors you talk about don’t resonate. Despite having all the resources in the world available to them, they feel they can’t stop.

Well I think those people have a better chance of quitting. They have family, they can afford therapy, they can talk to people. But of course no, I don’t want to say people who are riding high in society can not become very deeply addicted. So what’s left then in the formula? Probably the fact that addiction includes a very strong compulsive property, so when people have been addicted to something for some period of time, the psychological process moves from impulse to compulsion.

And that also involves in part, brain changes. The parts of the brain that become activated when craving is triggered by cues changes. So there’s something going on that makes it hard to stop for very good neurological reasons. So then, do you want to call addiction a disease? Well, maybe, then you’re getting close I think, because you could call it a pathology I guess. Because obsessive compulsive disorder, that’s a pathology right? So yeah, I think there is a point at which the line betweens those definitions starts to blur.

So it sounds like it comes to a point where perhaps addiction does fall into disease territory then?

[Pauses]. I wouldn’t say disease. I would call it disorder. Or even the adjective, “pathological”. But I just don’t like those words because there’re all part of this particular framework, and that’s the dominate framework in the US and parts of Europe, that this is in fact a chronic brain disease. It’s hard to talk about it as if sometimes it’s a disease or sometimes it’s not.

Then the argument starts to get kind of mushy. But when you are in the grips of compulsion, yeah, there is a process going on that of course isn’t healthy and requires a certain amount of cognitive and emotional and probably therapeutic work to get out of. So yeah, OK, I’ll grant you that you could call that, certainly, a disorder.

Why does it matter? Disease, disorder, behavioural problem? Does it affect the way we might think about treating those suffering from an addiction?

It sure does. The whole campaign to see addiction as a disease is that it works against people’s sense of empowerment. If you have a disease, you’re a patient. If you’re a patient, you have to take instructions from your doctor and do what you’re told. So people line up for rehabilitation centres and often have to wait for a long period of time, long after they’ve lost the motivational rush to actually quit.

Then if you do get into rehab, you’re putting yourself in somebody else’s hands and you’re going with the program. But the best way to combat addiction is through setting different goals for yourself and setting your own goals. “I want this for my life, I don’t want that, I want to change.” That kind of self-perspective change and self-development of future goals and orientation is critical.

That’s been an argument against rehabilitation, that it doesn’t always set people up to meet personal goals and readjust to society.

That’s right. It really hinges on the idea of who is setting the goals here. Who is telling you what to do? Are you telling yourself what to do, or are you being told? If you’re being told what to do, you fall into a position of helplessness or disempowerment, which makes it hard to develop this head of steam, this effortful strength and self-control and willpower.

I mean really, a lot of it is about willpower to master this thing, to take it in hand and change it. The best way to combat addiction is by setting goals for yourself.

Different types of rehab programs are needed for different types of drugs, for example it might take someone longer to get off ice than say, heroin, and therefore programs should be tailored to recognise that. But given what you’re saying, would the model of treatment be relatively the same across all drugs, because it’s more about willpower and setting goals than the type of drug being abused?

A good question. I don’t think so. Even though it has those goals in common, people are very different and there are many ways to quit. Some people will need to focus more on cognitive tricks to self-program to modify their behaviour, others will need to change their environment to make sure they don’t drive home past the liqour store, and for other people it’s much more of a motivational thrust, more mindfulness and meditation. For others, it’s about deeply connecting intimately and honestly with loved ones. Those are really different ways of getting better, even though what they all have in common is that theme of empowerment of self-motivation.

I can see why people with an addiction resist this way of thinking. No one likes to think of themselves of having a lack of willpower, or being to blame. Some members of the medical establishment are resistant to this idea too. Why do you think that is?

I think it’s partly ownership, it’s partly they way they’ve been trained to operate. I don’t hate doctors, there are wonderful doctors. But doctors are trained to look at things in terms of categories, diagnoses, which have a certain set of possibilities for treatment or certain sequence of things to try. It’s a really strongly inbred way of looking at very serious problems. And it’s hard for them to shake it.

Right, but we need some kind of diagnostic framework. Are you criticising the medical profession for needing to label patients? Because don’t we need to label people to some extent in order to narrow down treatments?

Sure we do. I’ve had a number of medical issues in the last few years and I’m damn glad my doctors have had a diagnosis and a treatment strategy. So yes, doctors do need to function like that. But it’s just I don’t think addiction is a medical problem. It has a medical side to it. So doctors should be involved in an adjunct capacity, particularly with drugs that produce withdrawal systems when you stop taking them. So doctors should help people with the medical problems associated with addiction, but addiction itself is not a medical affliction.

So what would you say to those who read your book, have an addiction, and have taken in what you have to say and want to know what to do?

'Drug addiction comes with huge amounts of stigma attached'

I’ve had dozens of emails specifically to ask that. People saying, “My son is addicted to heroin,” or “I’ve been addicted for many years.” I say that well, there are many different ways for people to kick their habit and it is important to think about where that habit comes from and social factors.

The person’s developmental stage is important, for example addiction is a different beast for someone in their 20s compared to in their 40s. Some people outgrow addiction and spontaneous recovery is just another way of saying people stop when it gets too much. They can’t handle it, and that often taken place when emerging through their 20s and into their 30s and wanting to start taking responsibility for their life in a different way.

Treatment depends entirely on who I think they are, and what they are going through.
« Last Edit: September 01, 2015, 01:03:01 AM by Chipper »
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Offline suboxstitute

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Re: Marc Lewis: the neuroscientist who believes addiction is not a disease
« Reply #1 on: September 01, 2015, 02:37:34 AM »
This is an argument/discussion/no, argument my husband and I have ALL the time.  Sometimes I don't know if it matters. 

I do know this - the first time I took an opiate (probably for wisdom teeth removal, age 14-ish) I felt different - energized, euphoric, etc.   That isn't something the majority of "regular" folks feel (husband, for example, falls right to sleep with 1/2 a 5mg vicodin.)  Ha.

So there is SOMETHING neurological/biological that causes the response to the first taste of opiates to be different for us.. and to make us do just about anything to get that feeling back again. 

know what I mean? 
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Re: Marc Lewis: the neuroscientist who believes addiction is not a disease
« Reply #2 on: September 01, 2015, 03:03:59 AM »
This dude sounds like one of those really smart dumb motherfuckers. He said when writing his first book that, " it never occured to me that addiction was anything other than a developmental phenomenon ". But then, when writing his second book, he said, " and it just came crashing down that this was a developmental phenomenon". I know its supposed to be a theory but still, he didnt seem to point out anything but his speculations and educated guesses. Seems more like a guy that knows he is smart enough to take information someone else could not and make it seem like a plausible enough scenario while having his name behind it. Its a good reas but his intentions seem a little vile. Just my opinion.
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Re: Marc Lewis: the neuroscientist who believes addiction is not a disease
« Reply #3 on: September 01, 2015, 05:27:06 AM »
I am always weary of these "addicts"
Who say they are cured and want to say that they know what is wrong.
I don't think he was ever an addict.
Maybe slightly dependent
And a rosey life other wise.
 
Tldr/ he doesn't know his ass from a hole in the ground
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Offline Zoops

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Re: Marc Lewis: the neuroscientist who believes addiction is not a disease
« Reply #4 on: September 01, 2015, 07:43:08 AM »
It's the old "nature vs. nurture" argument or question revisited and framed slightly differently. And it touches on some of the ideas from that TED talk we watched recently, about the addicted rats in solitary cages versus the ones allowed to live in "rat park" or "rat paradise."

Neither the environmental argument - that addiction is a response to one's environment and that socially and diversionally enriching that environment (making it more "fun") will solve the problem, nor the biological argument -that addiction is a purely biochemical phenomenon, a product of one's genetically predetermined makeup completely address the issue.

It's definitely a combination of factors. In every addict, there are aspects of both, but I believe there are very very few who do not have some genetic and biochemical factors at play in their brain which make it more likely that they'll have an atypical reaction to some mind-altering substance.

Like suboxstitute pointed out, when she first took some opiate, she had a different reaction than most - feeling energized and pumped up. I think most of us opiate users can relate to that. If you get amped from taking dope, then chances are you're one of us.

Whereas most "square" people say, "oh it just made me feel really sleepy" and maybe they also they'll say nauseated too.

Me, I can hardly sleep at all when I'm on dope. Except for catching a few Z's from being in a semi-conscious nodded out state, which is not really sleep.

Seems like Dr. Lewis completely cops out when he says "it's a disorder," or "it's a pathology," rather than acknowledging it's a straight-up disease. I mean it definitely is an obsessive compulsive type disorder, but isn't that the same as saying it's a disease?

I can understand how he thinks adhering to the disease concept of addiction can tend to disempower people in their efforts to stop using, because once you're a patient then you're under the care of someone else to whom you must look for answers.

Basically all he's saying is that  addiction is one potential result of a combination of environmental and biological factors.

So, yeah, interesting article.
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Re: Marc Lewis: the neuroscientist who believes addiction is not a disease
« Reply #5 on: September 01, 2015, 07:51:51 AM »
But if you take away most of the negative consequences of drug use, like the punitive laws concerning the possession of drugs, which would make it much more "economical" to be addicted to certain drugs, then you'd go a long way towards making a lot of people with the "disease" of addiction less "diseased."

Opiates are a prime example of this. Constant opiate use does not usually cause mental health issues like schizophrenia or mental deterioration like cocaine and amphetamines use can, rather the laws concerning their use are the most deleterious aspect of it.

Change the drug laws and you change the potential negative consequences behind drugs use, and the "continued use despite continued negative consequences due to use" diagnostic criterion goes out the window.

A chemical dependency does not necessarily mean addiction, and if we had total legalization, then we'd be left with a shitload of chemically dependent people rather than a bunch of sick addicts who need treatment.
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Offline Chip (OP)

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Re: Marc Lewis: the neuroscientist who believes addiction is not a disease
« Reply #6 on: September 01, 2015, 08:12:52 AM »
quality of life would rise for the users tho'
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Re: Marc Lewis: the neuroscientist who believes addiction is not a disease
« Reply #7 on: September 01, 2015, 08:18:30 AM »
This is interesting.  I think the dialectic he uses is wrong, however.  It is much more accurate (and backed by science via the https://en.wikipedia.org/wiki/Rat_Park experiments) to say, instead of addiction being a "developmental" phenomenon, it is more a social phenomenon caused by environmental factors, such as poverty.  Also important to distinguish is addiction versus drug use; the former being involuntary and the latter being a choice.  Using opiates was a choice for me; I didn't really care about being a dope fiend when I started, and I had more than enough chances to cease my use but I went back each and every time because I didn't want to quit.  However, as we all know it ceases to be a choice pretty soon.  There was nothing negatively reinforcing my choice to use dope every day when I caught my first habit (as I was incredibly naive as well); I'm a musician, "bohemian" in disposition, have a myriad amount of "mental problems" and was unwilling to take mood stabilizers that cause Tardive dyskinesia and would leave me with a habit but without getting high etc.............
The problems came after the "honeymoon" period, at which point you need opiates to function.  At this point, SOME individuals are given a choice; to either keep using opiates and maintain or seek treatment/detox. 

The "some individuals" is critical to this distinction, because those who are working class/proletariat/poor face MANY more obstacles in getting treatment that are directly related to economics and money.  Those who are middle class and those who have outside economic support are much more likely to leave their addiction behind than the working poor.  When I was sick of living the way I was, I was able to move away for a bit and isolate at my parents house.  So, someone without any support network, or someone who is the primary breadwinner of their family or who supports themselves, is basically fucked.  In addition, someone who does end up getting clean, but has to go back to their regular haunts due to money restrictions, is fucked.

If addiction is a disease and we are "completely powerless over our addictions" (like NA likes to say), how are we  supposed to get better?  I feel like this attitude is a hindrance to getting clean, and also a hindrance to repairing relationships damaged by addictions.  Do you know how many people I know who got clean/out of rehab, then instead of taking responsibility for their actions when using instead expected all their hurt loved ones to completely forget about THEIR pain and suffering because "it wasn't my fault at all I have a disease!!!!!"  I don't know of a better way to say fuck you to those closest to you!  The only way I got my shit under check was by finally admitting to my loved one(s) that I and solely I was responsible for everything i had done wrong, and that it is only my sole responsibility to make it up to them.
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Re: Marc Lewis: the neuroscientist who believes addiction is not a disease
« Reply #8 on: September 01, 2015, 08:32:01 AM »
owning it.
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Re: Marc Lewis: the neuroscientist who believes addiction is not a disease
« Reply #9 on: September 01, 2015, 11:18:23 AM »
quality of life would rise for the users tho'

Oh no question about it. I didn't mean to suggest anything negative at all about total legalization. I can see where someone might interpret my last statement in that way though.

Being "chemically dependent" is a slightly better look than being a "drug addict" is what I was getting at, or trying to get at.
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Re: Marc Lewis: the neuroscientist who believes addiction is not a disease
« Reply #10 on: September 01, 2015, 11:55:25 AM »
Karma for you Zoops.   :)

I also think it's a bit of both.  I think it's a disease simply because it does create changes to the brain, neurotransmitters, nerve pathways, etc.  I don't see how anyone can deny that.  They've done brain scans showing before and after changes.

I also think it's pathological in that there are developmental and behavioral aspects to dependency. 

At it's most basic level, the word "disease" implies being not at ease.  Dis ease.  Addiction and dependency is definitely that.

I also totally agree with what Suboxstitute was saying about stimulation v. sedation.  I always get stimulated when I use opiates.  They make me energized, social, outgoing.  When I first started using pods, I'd be bouncing off the wall.  Talking like I was on coke.  I also didn't sleep for about 36 hours when I first began drinking PPT. 

My family members, on the other hand, hate pain medication.  Whenever they get scripted hydrocodone or oxycodone, they'll take maybe 2 or 3 pills out the script, then either hide (from me) and save the rest, or they'll throw them away.  They say they make them feel "weird" and tired.  I don't understand that at all.  Completely opposite reaction with me. 
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Offline Lolleedee

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Re: Marc Lewis: the neuroscientist who believes addiction is not a disease
« Reply #11 on: September 01, 2015, 09:51:52 PM »
I also agree with what Suboxitute said.  I had that initial reaction to opiates too.  I was energized, focused and on top of the world.  I felt it gave me patience and the ability to engage more socially.

I think that the "disease" part of drug addiction is actually present before we ever pick up an opiate.  It is the way our bodies react that is different from the general population.  While I don't disagree that there are social factors involved, I think the biology that causes us to react differently is the root cause.

As an aside, I think people who hate opiates and claim they get tired and sick to their stomach are NUTS!!! :o
« Last Edit: September 01, 2015, 09:53:43 PM by Lolleedee »
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