Perhaps because so many of them are former drunks and junkies, ‘addiction experts’ are touchy people. Often they don’t like each other — hardly surprising, since they are fighting each other for such a lucrative business. You can make bigger bucks out of selling ‘recovery’ than by peddling drugs.
That’s not to imply moral equivalence, but the two do have one thing in common: plenty of repeat customers. In any media report of a celebrity’s battle with substance abuse, the words that you’re most likely to read before ‘rehab’ are ‘in and out of’.
Ah, say the addiction gurus, but that’s because they’re suffering from a disease. This is one area in which the rivals speak with one voice. The notion of addiction as an incurable, relapsing disease is the bedrock of the recovery industry. Especially the relapsing bit.
It’s a brave man who challenges the disease theory — especially if he is himself a specialist in addiction and therefore runs the risk of being cold-shouldered at conferences and savaged in professional journals. Step forward Dr Marc Lewis, a neuroscientist who spent over 20 years as a professor of developmental psychology at the University of Toronto before taking up a teaching post in the Netherlands. His new book is subtitled ‘Why Addiction is Not a Disease’. He’s not the only academic to rubbish the disease model — but, so far as I’m aware, he is the first who has done so by setting out a comprehensive theory of addiction rooted in neuroscience.
The Biology of Desire focuses relentlessly on the chemistry of the brain. That is what makes it the most important study of addiction to be published for many years. ‘Clear, insightful and necessary,’ proclaims the plagiarist Johann Hari on the cover — a worthless plug if ever there was one, but he’s not wrong.
Neuroscience isn’t just a fashionable subject: it’s all-conquering. Since the 1990s it has colonised one area of research after another. The human brain is the most complex object in the universe, and recently we’ve begun to understand how it works.
This makes neuroscience (which encompasses the entire nervous system regulated by the brain) a source of extraordinary promise and problems. Experts in one field after another have been forced to rewrite their textbooks; but their new findings are often out of date and sometimes discredited by the time they’re published.
That’s because neuroscience relies heavily on functional magnetic resonance imaging (fMRI), a non-invasive but very expensive type of brain scan that allows us to see different regions of the brain light up as we perform everyday activities. One day, fMRI may help us to reverse Alzheimer’s and other horrors. It’s not a tool we can abandon just because researchers
inevitably have to do a lot of guesswork based on small sample sizes.
What we must stop doing, however, is turning that guesswork into grand theories that try to explain human nature on the basis of fMRI images of the brain lighting up when people (for example) say a prayer, vote Republican or chop up a line of coke.
The study of addiction has been grotesquely distorted by ‘voodoo correlations’ between brain imaging and behaviour. In particular, as Lewis points out, fMRI scans have been a godsend to believers in the notion that addiction is a disease.
Observable changes in the brain caused by drug use became part of a simple, scary, media-friendly narrative of drugs and other addictive experiences ‘hijacking the brain’. And the fact that these changes were still measurable after an addict cleaned up his act was taken as proof that the ‘disease’ of addiction is irreversible.
Lewis is just the man to demolish this theory. First, he’s a seriously distinguished brain scientist. Second, as he revealed in his previous book, Memoirs of an Addicted Brain (2012), when he himself was a young man he was so ‘fucked up’ by his craving for a high that he stole opiates from the science lab.
In the end he broke the habit. And that’s how The Biology of Desire portrays addiction: as a collection of habits deeply engraved in the brain. Lewis says there is no reliable formula for overcoming these patterns of behaviour, which — as his gruesomely entertaining case studies demonstrate — differ markedly from each other in respect of both biology and social context.
The good news is that there are many different routes out of addiction, though the recovery movement does its best to block them by spreading the message that addicts are ‘powerless’ unless they surrender their willpower and their bank account details to its ‘experts’.
Lewis is an amiable guy and tries not to be rude about his critics. He can’t,
however, hide his contempt for most of the 15,000 drug and alcohol rehab centres for whom the ‘disease model’ is a licence to print money. The cold-blooded methods employed by the recovery industry have never been properly scrutinised. Perhaps they should be the subject of Lewis’s next book.
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