Hi again. I’ve been back home in the Netherlands for exactly two weeks, and there has been so little time for anything…so I have not posted anything. Lots of course work to catch up on. One new class started last week, and I had to prepare my lectures…with eye-catching Powerpoint animation, jokes that might seem funny to 21-year old Dutch students, and oh yeah, all that neuroanatomy that had gotten slightly rusty… I was a bit nervous. There were 300 of them sitting there chatting while I was standing at the podium clearing my throat. English is their second language, one they had to learn in high school. And Neuropsychology 101 isn’t intrinsically entertaining to everyone. The text book was dry, so was my throat, and how was I going to say anything comprehensible and interesting enough to get their attention off their cell phones?!
It didn’t go badly after all. I really got into talking about the brain. I pranced around the stage, pointing to different spots on my head and extolling the marvels of this self-organizing system of rapidly emerging subnetworks, that are the physical basis of all experience, a system that is designed to be underdesigned (because we need to learn almost everything we know — and that requires massive reorganization), and I’m talking about 20 billion or so cortical neurons, ladies and gentlemen, dames en herren, with 1,000 or more connections. EACH! That’s at least 20 trillion nodes, each node affected by complex concoctions of neurotransmitters, which tune them, just so, influencing how much information gets through, what kind of information gets through, and how we FEEL about that information…
Someone (I think Joseph Ledoux) boldly said: You ARE your synapses. That shifting configuration of tiny electrochemical connections: that’s YOU!
They were happy and smiling at the end. A good sign, I thought, except maybe they just liked watching me stride about tapping myself on the head. I had to wonder what was getting through to them.
I wondered the same thing, a week and a half ago, while participating in an hour-long talk show, via Skype. It’s called The Agenda with Steve Paiken, and a lot of Canadians watch it. So I was a bit nervous that night too. Behind me the camera picked up vague shapes in a dark, messy living room — watching it afterward, I thought I looked like a resident in some unlit chamber of hell, compared to the bright faces in the studio in Toronto. But the real problem was that one of the three other guests was an MD, a psychiatrist, named Peter Selby — a guy who does both research and clinical work — at this psychiatric/addiction institute in Toronto. CAMH, it’s called, I mentioned it in my last post. And he, like many of his colleagues, really sees addiction as a disease. But I don’t. So we argued about it. It was all quite civilized, but we weren’t seeing eye to eye. And yet he had some good points.
Politics and pontification aside, am I really so sure that addiction is NOT a disease? This is a topic that I’ve gotten into before, but not in much depth. I know how to talk the talk. I’m used to arguing cleverly that the “disease concept” of addiction is really just a metaphor, and a sloppy one at that. It can be useful. It helps us refrain from beating ourselves up if we think we’ve got a disease. But maybe it robs us of the sense that we can overcome it through our courage and our creativity — something you can hardly do with a real disease. I have some good sound bites… like: if addiction is a disease, then you must CONTRACT it at some point, and then you HAVE it, and then you GET treatment, and if the treatment works, then you’re CURED. And if it doesn’t, you have the disease until you die. I can talk like that, and I can smugly conclude that those are NOT the characteristic features of addiction. But now I’m not so sure, and I wonder if I’m the one being too superficial, too mentally lazy, to give this matter the attention it deserves.
Because Selby was right about one thing: “disease” is not such a simple black-and-white concept. Take Type 2 diabetes. You don’t catch it or otherwise contract it. Rather, it grows — it’s really a developmental disorder that comes about when people make bad choices about what they eat. Or live in unhealthy environments. And it’s not something you try to cure, it’s something you try to treat. The same could be said for quite a few “medical” diseases. Like high blood pressure? Like colitis or irritable bowel syndrome? Like carpal tunnel syndrome? When I’m on an anti-disease rant, I often fall back on the argument that brains change with development, they change with experience, they’re supposed to change: learning changes the brain, addiction is a kind of learning, it’s highly accelerated, it’s very focused, but it’s still a process of learning. So I’m thinking, diabetes, colitis….do they change the structure of your body too? Well, of course they do. And yet your body isn’t supposed to change in those ways. Aha! I’ve clinched the argument. Except that I have this intrusive thought: brain changes that come about with addiction are NOT so natural after all. Sure, the brain — especially the cortex and limbic system — is designed for its mutability. It’s supposed to be able to change with learning. But it’s not supposed to change so much that you can’t secrete dopamine in the ventral striatum without focusing on your drug or drink or sexual obsession or food obsession of choice. That’s a pretty fucked up brain, even if it got that way through a “natural” “developmental” process. So…is the outcome of addiction really distinguishable from what we call a disease?
I’m not going to go further with this tonight. But what do you guys think? Please share your ideas before I share more of mine. Yet we all have to try to leave our politics at the door before we get into this. Because the 12-step versus do-it-yourself versus the self-medication approach versus the “choice” position — all those territorial disputes take our attention away from the fundamental issue, the thing we really need to focus on. Which is: what is addiction? What is it really?
Informed by unparalleled neuroscientific insight and written with his usual flare, Marc Lewis’s The Biology of Desire effectively refutes the medical view of addiction as a brain disease. A bracing and informative corrective to the muddle that now characterizes public and professional discourse on this topic.” —Gabor Maté, M.D., author of In The Realm of Hungry Ghosts: Close Encounters With Addiction
What about the notion of “unhealthy reinforcement” as applied to
dopamine-based learning ?
The nasty part is trying to set an adequate “un-learning” or re-learning stuation/treatment/modality.
Slàinte
Unhealthy reinforcement — that’s pretty close to my favourite definition: corrupted learning. Reinforcement is obviously crucial to learning. And learning also consists of the more Pavlovian sort of association: cues leading directly to responses. So yes, I agree that this is a sensible approach, and the problem, as you suggest, is that unlearning is really difficult as long as the “reward” is still available to reinforce one’s behaviour. In fact, sporadic reinforcement is the most difficult to extinguish — a lesson I remember from undergraduate psychology.
The key to continuous abstinence from my experience (26 years) is to keep other options at top of mind. This can be done in the many ways you mention. The old responses are always there and are never “cured” — in fact, I have experienced how the addictive responses can manifest in myriad ways that are difficult to detect at the onset.
Behaviorally, I have seen that practicing different behaviors creates new pathways in the brain, i.e more options in the direction of healthy choices. To stay healthy, the addictive personality needs to make active/conscious choices to go down those paths. This is a rigorous and continuous mental exercise and the reason why support groups and mindfulness/meditation approaches work for the long term. All those active decisions create “decision fatigue” which make it harder to keep making those healthy choices. One more reason why starting over each day after a good night sleep is why we say it’s a “daily reprieve” and the one person who woke up first has the most “clean time”.
Wow! Where have you been hiding? If I had to sum up all the most important points, made by participants on this blog and in my book, it would be almost word for word what you’ve written here. Certainly your summary includes the best lessons from both brain and behaviour. We have to forge new pathways, true, but they also have to be kept active by conscious, volitional choices. Otherwise, the old habits, which have consolidated their synaptic stepping stones over many years, will regain their prominence and win out over the new ones.
Practicing is crucial, as you say. Practicing is the means by which synapses are strengthened, once they have been formed. That’s why professional violinists have extra dense cortical tissue in the part of the motor cortex corresponding to the left hand.
Understanding the brain shows us that the pivot point is not an analogy: there really is a competition between different synaptic networks, concretely, in terms of activation strengths. The network with more active nodes (or an equivalent number of nodes, with higher overall activation) will win out. Math models of neural networks clearly show that the competition is won, just as in natural selection, by a “winner takes all” solution. After a certain point, there is no middle ground. So the psychological pivot point not only corresponds with, but also is caused by, a neural pivot point.
Who would believe that therapeutic communities and support groups for addicts are based on principles of neuroscience?!
I wonder if we narrow our possibility of understanding addiction by seeing it as an ‘either/or’ experience –> either addiction is a disease OR it’s a choice OR it’s a result of brain injury OR it’s genetically based OR …
Every experience, every person, is composed of so many factors … I do recall reading that the word ‘addiction’ shares a root meaning with ‘devotion’ –> addiction as ‘devotion gone haywire’ …
Marc, I’m reading your book right now … You provide so many hints as to the genesis of addiction –> ‘a basic vulnerability of the nervous system itself’ … ‘the ache of homesickness’ … ‘this crisp, clear sheen of mental anaesthesia” … ‘Reality stops getting through to the brain’ …
Your understanding of how we ‘neuromodulate’ through ingesting different substances makes so much sense … I really appreciate your way of describing neurotransmitters, their actions and effects … That gives us a huge clue about what substances and activities we can be driven to partake of …
Thank you 🙂
Hi Jaliya,
What you say here is very compelling. Not only that, but you bring out the overlap of causal stories from my own book! You give examples of how I use the vulnerability of the brain, emotional trauma, and the particular soothing properties of substances themselves, all as converging avenues leading to addiction. So why can’t addiction be all the things we think it is? Like the blind men and the elephant, mightn’t it just seem different from different perspectives?
I wonder that a lot. And even the disease explanation, which I’m least comfortable with, starts to look good when you consider the diverse mechanisms labeled disease. And yet the three points you picked from my book might work together to point away from the disease model. A vulnerable nervous system, redirected or refocused by trauma, causes us to experience painful, upsetting feelings which are partly relieved by substances, which further focus the nervous system on relief. Somehow that sounds like a voluntary process that is MEANT to have a certain effect, even though the choices we make are obviously affected by their biological foundations, and even though they become more and more complicated and compromised over time. As long as there is pursuit and intention involved, can we really call it a disease? Of course we don’t intend the addiction, we just intend to get high, one more time.
By the way, the Dutch word for addiction is “enslavement”. Neither devotion nor enslavement is a disease.
I still think addiction is something else, maybe something unique. I’m just not sure what.
And thanks for your kind words about my book.
You’re welcome, Marc 🙂
A convergement of factors … that tends to be my starting point when I attempt to figure out what addiction is. Certainly there are commonalities … and there are the unique experiences we live through, and what we make of them.
There are cultural, social, historical overlays as well — I think that the usual Western ‘treatment’ models might fail, in part, because we (in the Americas, especially) tend to miss them when we’re searching for reasons and explanations. In some cultures (ancient and aboriginal ones), people who experience the existential changes of brain-altering substances are seen as shamans, healers, visionaries … There’s a long tradition of honour there, and such people have a definite and often revered place in their culture … Substance use in a sacred context allows for meaning … In our culture, it’s largely for relief, as you write … for escape … and perhaps as well for meaning, though it’s sought in a vacuum. You write that we change how we *feel* with substances that profoundly alter us … and I think that our deepest capacities for feeling are evoked through what we *can’t* lay our hands on — through our ability to feel in the first place, and our capacity and *need* for bonded relation …
Your book came into my hands at a most auspicious time. One of my cherished relatives is at a do-or-die point with alcohol addiction … and I have become, partially through default and partially through choice, this person’s primary support. I’m now into a second reading of your book … and it’s been a gift. How you think is becoming one of *my* primary supports, one of my own ways through. Thank you.
I used to work in the addictions field … and I’d love to see your book used as a primary text for anyone wanting to understand how one person can be waylaid and another not … I still marvel at my own road; I was well on my way to alcoholism by the age of nineteen, and ‘There but for the grace of Life go I’ … The danger passed; I was led in another direction, and to this day I still can’t pinpoint why I was spared.
It *is* a mystery … but your writing — the brilliant combination of your ‘blow by blow’ stories (no pun intended!) and neuroscience woven into the narrative — gives such clarity and coherence to a process that likely is inherent to the human (and mammalian) experience … I read accounts of bears getting wasted on fermented berries, cats getting stoned on catnip, and humans smoking a simple dried plant or ingesting a certain type of mushroom … and I think that perhaps we are indeed ‘hardwired’, in part, to experience existence through an altered lens … Then again, there are those 15% of cats who turn up their nose at the ‘nip. Why is that? It’s an instinctive turning away. Why? Another mystery …
Addiction as enslavement … ain’t that a truth!
You bring up so many interesting things, Jaliya. The shamanistic use of substances in other (e.g., aboriginal) cultures sure does contrast with our own preference for coke to make us feel spiffy, opiates to soothe our psychic wounds, and booze to let us sail through the awkwardness and boredom of our social worlds. And yet we also use drugs for purposes similar to the shamans. LSD and other psychedelics allow us to explore reality from different vantage points, and sometimes we come back with some smattering of wisdom. A recent essay in the New York Times Magazine describes how psilocybin and other psychedelics have been used to help people deal with their fear of death (http://www.nytimes.com/2012/04/22/magazine/how-psychedelic-drugs-can-help-patients-face-death.html?_r=2&smid=FB-nytimes&WT.mc_id=MG-E-FB-SM-LIN-HPD-042312-NYT-NA&WT.mc_ev=click). So we CAN use drugs to open us up rather than close us down, it’s just that we often prefer the opposite.
Which brings me to your relative. Can you help? You must know what a challenge that presents. By the last stages of addiction, we are so used to failure that we can hardly imagine anything different, and the pain of self-destruction is so severe that we want nothing more than to numb it.
Have you seen the recent studies and meta-analysis on the use of psychedelics to treat alcoholism? Here’s a link to a review of that work: http://www.nature.com/news/lsd-helps-to-treat-alcoholism-1.10200. Maybe you can be the guide or the shaman for your relative. If he/she is as far gone as you say, then perhaps anything is worth a try.
I’m very honoured by your words about my book. If it can help you at this difficult time… that would be amazing.
Good luck!
Marc, I think those are excellent points. “Contracting,” “having” “getting cured,” do not seem to mark out the broader concept of ‘disease,’ as your examples of Type 2 Diabetes, and Colitis suggest.
The same applies to ‘disorders,’ now the favorite terms of psychologists and psychiatrists.
I think both terms have a moral dimension. For what “conditions” are we prepared to NOT to blame the holder, esp. if he does something that affects us.
Consider the ‘madman’ on trial in Norway, Mr. Brevik, who killed a few dozen people including teens and children, in his fight against ‘multiculturalism.’ Surely he has a disease, or in your terms, his learning is “gone bad,” highly disordered and rigid and (assuming he’s imprisoned) maladaptive.
Alcoholics, addicts, druggies (you say it’s 10-20% of ‘us,’ yes? so I include myself) are suffering people, deserving of compassion, mostly, but we don’t want “I have the disease of alcoholism/addiction” to function as a total excuse. If a law is broken (we’ve been stolen from), we want action taken. And in some cases, “treatment” sounds too gentle: e.g for the alcoholic or druggie who drives and kills someone with his car. Our society seems to talk–daytime tv– as if treatment or ‘rehab’ is the preferred method of dealing with every act that harms others. I think that’s what the “It’s not a disease” people are really saying.
In that case, we’d expect the boundaries of ‘disease’ to be very murky; biology- based definitions in terms of body and brain functioning will never quite capture the agreed ‘diseases’ esp. in the mental and social realms.
Hi Nik, You bring up the moral function of the disease terminology. Indeed, “having a disease” relieves one from responsibility but it also makes one helpless, like a child or a victim. So it’s a double-edged sword for the addict: we addicts don’t want to be condemned as disgusting or evil, yet we don’t want to give up the sense of dignity that comes from being considered an autonomous human being. And it’s a double-edged sword for society. Society wants to TREAT those with disorders, because it often works a whole lot better than locking them up, isolating them, etc, but it doesn’t want to completely excuse the harm done by people who get smashed and do horrible things.
Thomas Zsasz, a psychiatrist, made waves in the 70s when he said, we shouldn’t decide whether to put someone in prison vs a mental hospital based on whether we think they’re crazy or not. Our definitions of craziness are completely inadequate and highly moralistic, so in essence, we’re in no position to judge. Rather, we should punish the crime, and admit we’ll never understand the intention behind it. Something like that.
So, if a drunk driver kills someone, he’s as guilty as anyone else is of manslaughter….never mind his addiction.
I kind of agree with that. But not only should addicts not be forgiven their crimes, they should also be able to maintain their self-respect and the respect of others. One of the big problems of the disease model, in my opinion, is that it undermines that kind of respect.
That said, I do think that addiction needs to be understood, rather than disparaged and scorned. And that’s a big reason why we need to approach it with a deep knowledge of its biological substrates.
Sorry, that should be Thomas Szasz — not a common last name.
addiction as a disease…….this venacular fits quite comfortably for many because it is a concept that might be easier to grasp than the notion that addiction is a consequence of complex and sophisticated epigentic processes. I think addiction is an outcome not a disease. Disease implies it can be “cured” medically, with the right pill or treatment. I think that venacular doesn’t fit either. The concept of disease fits well in a western allotropic 20th century world of the medical paradigm. Medicine is forced to view and deal with addiction reactively. In the 21st century we have the capacity to be proactively intervening with many little people to prevent vulnerability to major mental health and addiction issues,. Unresolved pain or overwhelming emotion lies beneath addiction for many. Consequences from addicted behavior impacts change for many. After 30 years working in crisis intervention in addiction and mental health my experience tells me that affiliation and attunement can affect changes in those who suffer from addictive behavior. Love is the drug…….
And yet affiliation, attunement, and plain old love could hardly cure a disease. We only wish!
I couldn’t agree with you more. The notion of disease is part of a world-view in which we have mysterious syndromes, badnesses or vulnerabilities that threaten our lives and challenge our sense of a moral universe, and yet which we don’t have the capacity to FIX. And so we have specialists — shamans in the old world and doctors in the modern world — who have the power to do the fixing. Yet both shamans and doctors have to take the same preliminary step: they have to categorize the ailment. And as soon as it’s characterized, it is by definition a disease, and it can by definition be cured, but only by someone wearing the right mantle and carrying the right tool-kit.
Don’t get me wrong. I love doctors (my brother is one) and they are the first line of defense for me when I’ve got a serious (physical) problem. But doctors are clueless when it comes to addiction — maybe because the first step, categorization, never gets off the ground.
It’s so difficult to escape this world-view and its application to addiction. Even the phrase “mental health” betrays our immersion in the world-view of diseases and cures. Yet mental illness may not be an illness at all. For a few decades now, the “anti-psychiatry” movement has tried to demonstrate exactly that. We need to learn a lot more about the brain and its foundational role in our experience, before we can develop a new (yes, 21st century!) world view to address its dizzying list of unique and frustrating outcomes (yes, outcomes).
Well….. I won’t cite the research but in my opinion attunement and attachment at the very least can impact vulnerability to addiction before it occurs. It is after the fact that we struggle with. Treatment works for about a third of the population who attend or have problems. I think we use approaches in treatment that don’t get to the brain, or right parts of the brain, always, because they are focused on the neocortex. We like talk therapy. We also don’t know how to adequately identify vulnerability in adolescence or know how to effectively intervene early in the process. Lets talk about some of this Marc.
HI again Jan. Attunement and attachment can certainly be potent approaches to reverse the path to addiction. I didn’t mean to imply otherwise. I meant that love doesn’t work to defeat disease as it is commonly defined. (although there is good evidence that mood has an impact on recovery from physical ailments, and love makes us feel good….so, it sure can’t hurt.)
I’ll go you one better: I think that attunement and attachment are the BEST weapons against the development of addiction, especially in adolescence. Close, candid, perceptive contact from my parents, while I was in boarding school, would probably have changed my course radically. I didn’t get it. I became an addict. Talk therapy is further down the line. I does provide attunement (we hope), but success rates are not great. An hour or two a week just isn’t enough.
And by the way, we are learning some things about vulnerability in adolescence. See this article, currently linked from my homepage: http://www.sciencedaily.com/releases/2012/04/120429152251.htm. I plan to post on it soon.
We know that impulsivity is a predisposing factor. But that’s only a start. First, impulsivity isn’t as heritable as people think. Genetic correlations are present but not high. Second, there are many kinds of impulsivity, dependent on different patterns of activation and deactivation of cortical and subcortical systems. Third, impulsivity is kind of a blank term, waiting to be filled in. If the impulses take on the hue of adventure, bravery, liberation, triumph, or even vengeance, then there is a greater likelihood that we’ll follow them into the world of drug (or alcohol, or cigarette) use.
Addiction is a mental disorder therefore it is a disease. Obviously not an infectious disease but more like cancer. , genetic predisposition with environmental or husbandry type of predispositional triggers. Mark is a brilliant man with intellect beyond mine, but his trees are blocking the forest in front of him.
Doug, please read the comment above yours, by Jan. Do you agree that this is something worth debating? It just can’t be that simple, or there wouldn’t be so many diverse views and so little progress in coming to a resolution.
Argument by definition can be useful for discovering categories, but it can also be a way to short-circuit the full discussion. Yes, a disorder may be a disease, by definition. And a tomato may be a fruit, by definition. But it is more helpful to know how to cook a tomato, or what kind of salad brings out its best, than whether it’s a fruit or a vegetable.
Most people think a tomato is a vegetable. They happen to be wrong. But from my perspective, the very fact of A TOMATO wrecks the fruit/vegetable dichotomy. The category definitions just stop working when it comes to tomatoes.
It is definelty worth debating. I didn’t mean to come across as if addiction is a no brainier disease. In fact it is a disease in my brain only as a sort of nomenclature. I like to name things when I see a bird I want to call the species of bird not just oh look at that song bird or raptor. There is a reason to name things beyond just being anal retentive and calling order to an otherwise unorderly world. The reason is you can treat or change things that your mind can grasp, and to grasp it, it needs a specific name. Addiction is the specific epithet of a broader classification known as disease. That gives my pea brain a handle to deal with the disease as opposed to calling it a unknown phenomena.
It’s just a thought,that needs a proper classification.
.?
Doug
Doug, I understand what you mean. In fact my brain works in a very similar way. I like definitions, categories, and I like being as specific as possible. Just as you say, it gives us a handle on things, a way to solve problems and move forward.
I give myself the same advice I gave you: Not so fast! Definitions are often the first step in problem solving, but it can be the most difficult step. This is especially true with addiction, where we often don’t know where to start solving the problem: whether to help a friend or to wait, or whether we’re ready to quit or not, total abstention or harm reduction… etc. So I’m hoping that, if we get the definition right, the rest will come a little easier.
Just thinking out loud,,. If we can have healthy or so called beneficial addictions to such things as excercise, eating healthy, and making good choices in general. Assuming that said addictions do not harm the addict ie excercise to the point of damage or neglecting home or work life, then it wouldn’t be a disease. While addiction to a drug of some sort almost invariably does some harm to the body,mind and life functions in general, that would be indicative of some pathological process. Those so called addictive personalities are predisposed to an excessive use of drugs or behaviors that can become an addiction. So, it is really a personality disorder that allows the excessive or perhaps compulsive use that leads to the biochemical addiction to a substance or a behavior. In this category addiction is an end result of a mental or perhaps personality disorder/disease. All though, addiction to an appropriately prescribed pain med for instance, is often not a personal choice but is an iatrogenic cause of an addiction. It then becomes the addicts choice to continue or not wherein the predispositional disorder decides to take the risk of satiating the addiction or not. Clearly the cause of most addictions is idiopathic but there must be some definable mental state or disease condition that leads one person to addiction and another to avoid addiction, in similar situations.
I could see that a test of some sort exists or will soon that can identify these tendencies. The results would be useful for prevention and nefariously so for health insurance.
Sorry for babbling but this disease thing is keeping me up at night.
Good night
Doc;
Things are going great toward all vectors on this issue. Enjoy of course but like Real Estate it is Topic. Topic, Topic. I know you will not forget but drift and “mission creep” are idiosyncratic concerns of mine
Always invoke “Halo Effect Bias” during a presentation. Bounce up on that stage and “Twist That Lewis”. This is essential to gather the consciousness of a mass of people for the presentation to be success in a “crowd sourced social situation”.
The larger any given group becomes the more irrational/emotional it will be in aggregate and since your message is ESSENTIAL you are obligated for reasons of professional ethics to proceed along proven pathways of mass communication. Yes, a LOT is known about this especially in the last 20 years of vigorously scientific behavioral research.
We know that obtaining a GOAL can be done through a knowable, provable process. The more we adhere to the statistically indicated most probable path which is almost seems predetermined in our peculiar perception the greater the success!
Added bonus hint: this will also resolve the apparent “contradiction” between Newtonian and Quantum Mechanics for you if this is an anxiety point for you and your loved ones.
This is a boomer if you can migrate your synapse cloud ( another hint) over those coordinates!
Mike, what are you ON? (about?) I am trying to work with the quantum mechanics, but I’m really more classical at heart, as I think you have discerned. Anyway, I’m as vulnerable to the halo effect as anyone, which means I like the attention, and it makes me better. It makes me think better, write better, and care more.
Marc:
You are misreading the intent/message.
I am STRONGLY urging you to use the Halo effect to the max in order to BOOST reception of “the Marc Lewis Message”.
Please do not read cynicism into this.
I am concerned you will not leverage the halo enough.
Any “crowd” is not rational even in the unlikely event that all the individuals are if all in separate rooms for counseling interviews.
Therefore: To teach a crowd, please utilize crowd psych dynamics not your excessive modesty. On the other hand springing into the therapy space for one on one with a big toothy grin might be better done, no?
🙂 Admittedly I had been listening to a broadcast of pre Brit/Beatles Rock and they beamed out “Let’s Twist Again” by Chubby Checker hence the image of “Twist that Lewis” which was a musical reference not as in “Twisted Marc Lewis” or “Twisted Message” or anything like that 🙂
This does not mean a tight sharkskin suit, pointed shoes or processed hair for you either… more of a metaphor thingie 🙂
I didn’t think you were being cynical. Yes, I am riding a halo effect. I imagine that that is often an important component of “buzz” — publicity that comes in waves. And I meant what I said: all this admiration, besides sometimes being embarrassing, does have a beneficial outcome. It makes me think better, write better, and care more, because I don’t want to disappoint, and also because I feel that I owe something in return. I want to live up to the admiration, but I also want to provide insight and knowledge in return for the profound gift of being seen as “valuable”.
So I do think I’m “leveraging” the positive attention: turning it into a motivational engine that allows me to roar down the highway without looking back.
Now as to the question: addiction, disease or not ?
To me the following is 100.00% fundamental:
The “disease” advocators are inviting/DEMANDING that you violate and negate your cognitive capability to pattern match and stereotype and to throw the Scientific Method right out the window with the bathwater and the baby and return to the comfy darkness of the Middle Ages for their notion of the “Greater Good of the Volksgemeinschaft”.
These people are approaching this as teary eyed, hankie twisting do-gooders who prefer formulations that are dangerous and obsolete leading nowhere.
Imagine a nation/country where 90% of the adults and 70% of the subteen population has a Body Mass Index over 30 which is the tech definition for “obese”. Okay, the “cause” of this state is too many people voting with knives and forks allowing their animal bellies to rule over what “human” potential they might, MIGHT have had at some point. Across the entire nation in an exercise of “Democracy and Freedom of Choice” ( such noble terms!) the people have eaten themselves into a state of morbidity. Also assume that aside from epidemic obesity related illness The People widely feel an enormous discomfort, lack of esteem and a true sobbing sadness in this matter.
Now, after YOU ( Dr. Marc Lewis, Neuroscientist) deliver a presentation outlining that the Mob is simply consuming FAR MORE energy than they are burning and that if they would reverse this to burn more calories than they are consuming the “crisis” would self resolve by the proven, proven, proven application of scientific research and technology.
At the close of your talk the auditorium is so quiet you could hear a Dorito drop… then the social symmetry collapses and the whole crowd explodes into uncontrollable sobbing and gasping.
As you stand aghast you are quickly approached by a committee of clerical do-gooders who demand that you witness what your savage inhumanism and cold, EVIL, calculating intellect has wrought and that you should accept your responsibilities for crimes against the people!
Now, save yourself and ADMIT that “Obesity is a Disease” for the good of the nation and, indeed of all Humanity. Address the MOB now and admit your error – retract your statement(s) and get back into line OR accept your responsibility if the mob begins to kill and burn.
So your choice is stark! You are a scientist OR a politician.
Dismiss this addiction as disease model. I mean right out of hand, you will not discuss it anymore than you would debate “Creationism” with some damn snake dancer in Appalachia. Christopher Dawkins and others have done heroic work trying to cast out the “Witch Doctors” and mob massaging demagogues but this is VERY tiresome “work” with an unquantifiable probability of goal attainment. It could well be a “state of the world” that cannot obtain in a million or a billion years speaking in statistical not mythic terms.
Marc, that kind of bulk exorcism is young man’s work and we are way too old for this sort of endeavor.
If you have some colleague who you determine openly or covertly denies Newton, Bayes, Galton , Darwin etc etc just walk right away from them.
You are truly delightful. I laughed a lot and read your manifesto (and prelude) out loud to those in the room with me.
What can I say? I just don’t think it’s that crazy. As I think I wrote in my post, the notion of disease continues to evolve. My doctor friends tell me that diabetes is now understood as a developmental disorder, not that different from cancer, and yet it is obviously a treatable medical condition.
You’re right, there’s a political issue here, which is why I asked respondents to leave territorial disputes at the door. (Did you catch that?) And yes, there’s often a crowd-pleasing side to the disease position. But I have heard thoughtful, intelligent and progressive people refer to addiction as a disease, and sometimes they are looking straight at it. The difference between what seems to be and what is often remains obscure.
The bottom line is that — okay let’s go with your quantum metaphor: if we don’t collapse the wave function, if we allow the ambiguity, then the universe remains a whole lot more interesting for a whole lot longer.
By the way, your obesity stats are way off. They seem to relate to a bmi of 20, not 30.
“IMAGINE a nation or a country where 90% etc.. see cognitive error Doc 🙂 These are the faults we are all prone to on an excellent day- it is so easy!
US adults and children are hugely, enormously obese.
25-30 overweight
30-35 obese
and now we have categories with labels 35-40, 40-45
Very, super, mega, ultra.
Certainly YOU are both the Doctor and the Boss AND right on the spot taking feedback, etc. There is a job you are doing, I appreciate that. Anyone no matter how intelligent has the same or similar pattern of faults in their cognitive processes – see below :-).
Any person abusively doping themselves with food, booze, drugs will develop a huge panoply of manifestations of disease.
So? If you have extreme rosacea of the nose due to swilling gin we may refer you to a dermatologist. There, a skin disease.
So the takeaway is that this is a politically imposed cognitive error which requires the sinner ( you) to subordinate higher cognitive function for social comfort.
This is not “wrong” though it will blow all your research out the window going forward.
Educated people had known the Earth was a sphere for centuries and that the Earth was just one planet. Galileo was persecuted though all the educated people in the Church knew he was correct and this was done BECAUSE reality was considered socially disruptive.
You know that everyone will feel a lot more comfortable if you aver that their 600 lb body is caused by a “disease” or that the diabetes they have which was generated by chugging sugary food literally by the kilo is a “disease”.
Surgeons are now beginning to yank gall bladders out of subteen kids because their parental balloons have killed these bladders with kilo after kilo of lard, greases and fats.
If they beat the kid on the head with a hammer would the brain damage be a “disease” smoothed over in the doctor’s office or should the Police be called immediately. It is the exercise of willful damage against a minor not, by definition, responsible for his/her own actions.
You and I are “USERS” and right from the moment we started doping we knew we were risking our lives and any chance we would ever have.
If there is any true “disease” it is in that weak brain link suppressing impulse and requiring slow, painful, energy consuming “thought”.
To beat addiction one must amplify the intelligence and painfully impose impulse control and deep acceptance of the existential reality of human anxiety and misery and that you CANNOT be happy more than once in a while and if you have a particular inherited temperament you may be rarely or perhaps never happy in life and you must accept this.
IMHO the key to your success has been inordinately high intelligence that managed after 30 years to reason with you into impulse control.
For the less intelligent, if they will be free again, even briefly, they must establish impulse control.
Please show us those “diseases” not rooted in substance self abuse which can be cured by impulse control alone. Can a brain tumor or uterine fibroid be “cured” by impulse control?
If some tenured scientist comes forward and states that they hold that Creationism has a scientific basis should we not dismiss him to the Ceramics of Theater Departments at the minimum?
What of the politicians who insist that obesity is a political condition caused by the machinations of “the rich” determined to fatten the people for profit?
Then there are the clerics decrying gluttony as one of the seven deadly sins and all this public debauchery as a “spiritual matter”…psychoanalysts will decry repressions and redirections.
One can go on and on so you see that there will be an endless parade of false pretenders and as we consider them and their flood of tears we shall arrive exactly at nowhere
Indeed, the capacity to reverse addiction through the exercise of self-control seems to argue agains the disease definition. But it is not fully convincing. We have a friend with very high blood pressure who will not try to reduce the stress in his life. This lapse in self-control may kill him.
Self-control, or simply intention, is always present in some form as we live our lives (unless we’re in a coma). These things — let’s just call them “will” for short — can help us to stop doing the things that cause the undesired outcome. If the outcome is diabetes, we put it in the disease category. Thus, WILL has reversed the disease process. Why can’t we say the same thing about addiction?
So I don’t think the disease model is a “flat earth” argument. I think it has merit. But I still think it’s wrong as a definition (and in that you and I seem to agree). It is just a metaphor. Then the question is: is it a good metaphor? I’ll tell you why I don’t think so, in my next post. But readers here, including yourself, are already expressing that view, in ways that are both conscientious and compelling.
I may see the pivot point here, perhaps not.
In order for any therapy to proceed it may be required to supply the dysfunctioning “patient” with some narrative to which that patient can subscribe fully. While they many have arrived with some complaint about too much self injecting we cannot assume that he/she be enlisted in seeking a “cure” wholly or even partially. This is especially true if a GREAT effort will be required by the patient. If you weigh 360 and you should weigh 120 ( BMI 22) then YOU will have to burn a huge amount of calories through exercise while simultaneously exercising draconian control on calorie intake if gastric surgery is off the table. The Doctor cannot run back and forth to Moscow to effect a cure. If the patient is not prepared to do this for themselves no progress may reasonably be expected.
So, if I deliver a narrative to you that your addiction to eating or injecting is a “disease” and this statement induces you to behave in a way that is positive then that is “good”. If I supply a narrative that you are weak willed and must strive to boost self control to reduce bad behavior and THIS narrative causes you to fatten or inject MORE skag then the therapy is a failure.
If you are teaching a course for future addiction specialists you might have a section on testing and interpreting the client personality with an eye to selecting the narrative that will induce enthusiastic cooperation in reducing use.
Where we may go wrong is if WE take these tactics as truth and the result is the distortion of the scientific project which serves as the driver for truly effective therapies.
if we narrate to a junkie who is comorbid for religious delusions that after praying over their file you understood that Jesus does not want them to shoot dope and that WORKS where is the problem?
The problem will be if YOU believe it. After that therapeutic success you might assert that “religion” is the answer.
Naturally what you do is very valuable to me and my view from your writing is that you got freer by cognitive means and I am trying to weld that into place.
If you were a genius level native carver I might stress a VERY different narrative. You, yourself, might not bite if I narrated to you that shooting dope was an affront to the ancient prophets and the ancestors. You might do better if i suggested even more rigor in your cognitive functioning. 😉
Potentials of the human brain:
WE have shown that the brain signals within its domain at the speed of electrochemical reaction and this is INCREDIBLY slow.
Blindfold and block the hearing of the experimental subjects.
Apply a HOT stimulus very gently to the bottom of the foot noting the EXACT time.
Record the EXACT time the foot is sharply withdrawn.
Test subjects repeatedly over a representative population not just uni students.
Grind the numbers.
This gives you a baseline for practical time of cognition WITHIN the body on a very simple “problem”.
So if this is our linear processing time how is it that we were not all eaten long long ago?
The answer is though “dead” slow the human brain has massively cross connected a huge number of nearly worthless neurons in what is called a parallel processing platform.
This is somewhat like building a car with a flat bottom that carries millions of lousy little tires because the auto industry just cannot get any really good tires so as to reduce the number used to 4.
Giant freight planes often sport landing gear like this.
NOW, the ONE property that this otherwise poor quality brain can do cognitively is PATTERN RECOGNITION that only functions due to the use of STEREOTYPES some of which must be innate (patterns) and some of which must be learned or derived either from some sort of “teaching” or by information gathered from experiences, media and so forth.
Damnable Do-Gooders often demand that you surrender the ONE and ONLY cognitive capacity you could ever possibly have “for a better society” in their view. You will not be asked to consider this proposition and to agree, freely, to surrender your brains or not or to one degree or another.
They DEMAND your surrender at the cost of social ostracism up to and including fines and imprisonment and a vigorous policy of judicial murder in European History broadly up to 1955. 1955 not 1945 and latterly in “The Balkans”, Ireland, etc. tomorrow if not today
This continues to this day to one degree or another though one must tip the hat to the Dutch Nation. For centuries they have been an irreplaceable and we might be very close to nowhere in Europe without them. I salute you all!
Back to the core here:
If you surrender or severely inhibit your capacity to parallell process, and pattern match on stereotypes you surrender the only aspect of what you are that makes you human and that is that the Synaptic Probability Cloud that arises from these pattern matching roots. That IS you, that is the Ghost in the Machine and the only “thing” that ghost can ever be.
Now if YOU prefer to remain closer to the Chimp, the Cattle, the Horse, the Fish for reasons of “personal comfort” simply leave the University and gather with your snacks, guitars and blankets in the park. BBQ, drink some alcohol, smoke some weed, play a little music and mate while you enjoy watching and listening to the other members of the tribe sing, drink and mate.
No criticism from me “On the Beach” or “Sunday in the Park” but PLEASE get out of the lecture hall with your non negotiable demands to label obesity and dope addiction diseases just to make you feel better about your cognitive FAIL.
Interesting…I often vacillate back and forth regarding whether I can categorize addiction as a “disease”. Yes, addictive disorders do stem from a set of predisposed factors that dynamically interact with environmental stressors. Those predisposed factors will steer individuals down a path of maladaptive alterations in reward circuits that underlie addictive behaviors and are enormously difficult to counteract. In some ways, the addiction is never gone. It’s like being an insulin-dependent diabetic: the malady is there, but it can be mitigated or even virtually inert with proper vigilance. I wonder if the strict “disease” categorization stems from a need to counteract a previously present (in some places, still present) percept that addicitons are simply a failure of cognitive control and the people that fall prey to addictions are just “hedonists that can’t get their act together.” Sadly, it’s hard to make policy change by presenting the true nature of the science, where there are many shades of gray. However, this type of debate needs to continue in academia if we are to make real progress!
It just popped into my mind, as Marc pointed out, that this debate over the degree of “disease-status” of addiction is necessary for the sake of the patients and caregivers. We need to inspire within those with addictions that their current state is surmountable, albeit a struggle. Are there words/metaphors that effectively convey the debilitating nature of addiction while still affording a degree of personal control that can be empowering for individuals that want to overcome their afflictions?
Yes exactly,
What you will be capable of derives from how a given issue is “framed”. If you accept the “framing” you will “anchor” in your views. Everyone does this 100% of the time.
If you accept that addiction is a disease for which there are no antibiotics or prepared cures you are washed up.
Marc has achieved a brilliant outcome because he do did not take this route. Otherwise decades later he would still be sniffing around the back door of the Pharmacy for his methadone and other meds.
If a discussion is started on the premise that “The Earth is Flat” yes or no as a valid position where will we end up?
These are procedural issues/approaches designed to block progress and discovery. Every grad student who likes no avoid preparation before seminar knows them.
But Professor, isn’t addiction REALLY a disease, I mean fundamentally? Seminar destroyed and the fact you did not get the reading done safely concealed.
These same people will still be called “Doctor” after graduation though their failures will be visited upon the shoulders of their defenceless patients.
Of course the questions are good from a research standpoint, but what about policy? In the US, we have to demonstrate that birth control significantly improves public health for women. How do we do this to make effective policy with addiction by providing support for those who need it while, at the same time, not labeling them with a “disease” category. If we steer too far away from addiction as a “disease-like” state, we run the risk of equating the phenomenon with “heart disease from a failure to eat properly” (which, palatable food intake can certainly lend itself to addictive behaviors…but that’s another story) or a “failure to exercise control over one’s actions during a shoplifting trial.” My question is how do we convince legislators that this disorder is not simple to overcome and takes years of support without defining it as a disease? Would it be sufficient to compare addiction recovery to physiotherapy after surgery? How about the risk of relapse? I mean, there is evidence that drug exposure (even just one exposure) induces brain changes that can sensitize rats to the locomotor-stimulating properties of a drug upon re-exposure up to one year later! The brain changes are permanent. Addictions have their influence on individuals for likely the rest of their lives, but adaptations and strategies to quell their influence can be learned. How do we convey this to policy makers that seem to need concrete answers to make definitive decisions?
Hi E;
Okay I have to pick you up in the effort to “frame” women’s reproductive rights with drug addiction. This is not a good association for any of us.
This is one of the points we can take from the study of decision making, behavioral finance, risk management all of which are bonanzas of insight.
Our greatest obstacle is educational weakness at a fundamental level and general human weakness in rational oversight.
***
In some ways this reminds me of the entire “God is Dead or Not?” discussion. Please bear with me for a moment 🙂 If there is a God, then God is Free. If God is Free then Man cannot be Free. This was fairly well wound up by the mid 1600s and most were pretty pleased with the idea of Human History as a sort of Godly Show wherein the general course of events was determined by Him to test us love us, save us etc.
Following the Total Catastrophe of WW 1& 2 and the opening of the “camps” we, as a “Culture” demandes that Nazis and Communists be held accountable for their individual actions and not seek defence by referring to the course of history, nature of war, will of God to try man and so forth.
We INSISTED that Man was Free and if that were the case then God was out of the picture ( “dead” as a relevant concept).
***
The take away point is NOT whether Humanity REALLY is free or not or if some person is free or not. We will simply insist on that. Sadly this view only has seen wider acceptance since 1945 so it is still very poorly integrated.
***
Point? 🙂 almost there.
The start with any junkie is: You lost your freedom, your Human Right. Do you want to try to get that freedom back? ( no right answer here). There is no trusting junkies so the answer must be backed by observed behavior.
If some person simply wants unlimited drugs we are wealthy enough as a society to afford them and can take a liberalized, hospice view. We aver that these people are at the end of their lives and we will keep them comfortable according to their expressed choice at a level they might choose with no hack medico meddling or do-gooder hankie twisting. “What’s best for you…etc”.
If on the other hand they themselves demand that they were free and demand to be free again we have all we need to treat them in hand now and grow more capable every day.
***
Frankly, politicians are terrible, terrible people and they are not going to “fix” anything including Finance, Education. Crime, Military Crusades…nothing other than lining their own pockets with pensions, perks, loot.
Besides resources no matter how much they grow in real terms are alway limited. Regardless of the “issue” we cannot have scores of millions throwing themselves at the Treasury of any nation with demands for support that are virtually limitless.
Yes, “Woe to the Conquered” that will be part of the human condition whether you are conquered and enslaved by Nazis or the dope peddler on the corner.
I am reading your dialogue with admiration. Elizabeth, you state the problem very effectively. Mike, you are very well tuned to the political side of the “addiction as disease” issue, and you provide some important perspective on this theme. Elizabeth, you are looking for an inroad, a fracture, where society can make room for addicts to get help without being further humiliated. And then you argue that this rabbit hole, whatever it is, might be suitable for practice but not for a scientific/academic discussion of what addiction really is. And I totally agree.
I want to get in on this dialogue too, and I will. Give me another day or two to catch up with you. Meanwhile, great dialogue! Thanks for your insights and your energy as we explore these murky waters.
What can I add? In the posts and replies here, there are many who agree that the disease model has a function — beyond it’s ostensible function, which is to help EXPLAIN addiction. That “extra” function is, as you say, Elizabeth, to counteract accusations of laziness, self-indulgence, weakness, and much worse. As Mike quite forcefully points out, the disease nomenclature seems to save us from our excesses. At least it saves us from being held responsible for them. Sometimes it seems as if we label everything from shopping compulsions to obesity to end-stage gasoline sniffing as a disease. That’s when it becomes obvious that it just doesn’t cut it, logically. But is it still worth it, as a metaphor, to help us save face? I don’t think so. As I wrote in response to Nik, above, seeing addiction as a disease reduces our sense of ourselves as intentional, deliberate agents, it makes us victims, and it invites us to stop trying, even as it protects from disparagement.
You’re right, Elizabeth, that shades of gray don’t sell people on policy changes as much as do bold proclamations. So the search for the true nature of addiction gets buried under an avalanche of words, claims and counter-claims stated in the most inflammatory ways. I guess that’s why scientists make lousy politicians and politicians often ignore science.
Obesity can at times be a symptom of a disease, hypothyroidism, food addiction,OCD to name a few. Addiction in general depending on the particular vice one is afflicted with, is a mental disease. Many diseases are not curable some are treatable, addiction is the later. Are we to believe that depression for instance is also not a disease. Granted, depression can lead to addiction just as addiction can lead to depression. If addiction is not a disease and I believe it generally is, unless of course it is a symptom of another disease, then what is it? A choice? Oops I accidentally got addicted, now my addiction disease(choice?) needs treatment.
The remarkable thing about marks book is how he went off and on hard IV drugs and went through withdrawal with no help. The few addicts I have known all needed help to treat their disease. Be it primary addiction or addiction as a form of self medication for a separate disease like OCD, depression ect.
I work on non primate animals they don’t have this particular disease.
Did they snort “depression” up their nose or inject it into their arm?
What junkies think their state is will determine their outcome to a degree.
If you prefer huge numbers of shuffling dependents you want to think “disease” and you especially want the drunks and dopers to see themselves in this self pitying way- much comfier for everyone.
First thanks for posting your presentations slides Marc. I would love to hear you in person someday. (Perhaps you can come out to BC for a talk.
Secondly, regarding your question: is addiction a disease….
Honestly, as another person with an ‘addicted brain’, the first thing I did after purchasing your book last year was to flip to the final chapter to find out how you quit drugging and drinking. I loved the book, loved having new ideas about how and why I have this problem; however like many or most addicts, the thing we all want more than knowing why we started, is to know how to stop.
So to me, its an academic question more than anything else; although an important and worthwhile one.
Also, I find it so interesting that the WHY is framed in neuroscience, but the how to stop ideas (simple and practical) still share much with people who try to heal using the disease model….ie: I have heard these things at AA as well). I think your next book should be a whole book about how to quit, framed in neuroscience 🙂
Keep writing and speaking Marc. Your work is very helpful to all of us.
Hi Michele. The other day I found myself trying to explain to an undergraduate class why we study the brain as part of an education in clinical psychology. Knowledge about the brain can lead to two different treatment approaches.
(1) If you know what part of the brain is working in some undesirable way, then treat the brain. This usually means taking a pharmacological agent (like Prozac or Ritalin) to correct the problem IN THE BRAIN. But drug therapy always causes some problems while relieving others. Brains get territorial and protective of their habitual chemistry. And so there is usually some kind of rebound or reaction (like tolerance, withdrawal syndrome, side effects, etc) that isn’t nice. So we go to…
(2) Let our understanding of the brain make us more aware of the totality of human function. We are biological creatures, and the details of the flesh are directly correlated with the details of the mind. So..nonpharmaceutical treatments, like psychotherapy, AA, mindfulness, etc, will be better informed, will work better, and will evolve more progressive methods, if we understand the NEURAL correlates of addiction.
Knowing something about muscles and tendons doesn’t mean you have to perform surgery to cure a bad back. Rather, that knowledge guides our approach to exercise, posture, and so much else.
I guess I’m a brain chauvinist.
Funny … I think I’ve become something of a ‘brain chauvinist’ too, if I catch your meaning accurately, Marc. My own perspective on illness / health / addiction / emotion, etc. has become much more scientific over the last decade or so. It’s had to, in part, in order for me to understand my situation — long illness and aftermaths of injury to my own brain — and I’ve found that a brain-based starting point has helped me to clarify things … I am amazed at what awareness and *conscious* intentionality can do to effect change, and how quickly and thoroughly we can derail ourselves … I do believe that any treatment which engages awareness and intention has a better chance of ‘sticking’ than any treatment which is passive (i.e., drugs or anything that is ‘done to’ a person).
Funny, too, how an admittance of ignorance is often a starting point for turning ourselves around. Even with our amazing brains, we have to be down and almost out before we’ll begin to make changes … We are such creatures of contradiction — !
Indeed, conscious intention can have huge consequences on the progression of neurobiological states. So the most important thing is to reconcile intentionality with brain processes. This has been incredibly difficult, and it leads to arguments in philosophy more than psychology and neuroscience. Can everything be brain-based and biological, if intentionality can enter the picture so easily and have such massive consequences? I think it can, but it’s very hard to think about.
A few months ago I summarized the biology vs. free-will debate. Take a look: https://www.memoirsofanaddictedbrain.com/connect/not-quite-free-will/
First off, I’ve heard Marc talk and I so wish this was a video rather than powerpoint slides. I can’t tell you how moving and REAL and good and honest and mysterious this whole addiction thing can be when lit up by an academic still struggling with the science of subjective suffering.
To the point about disease vs… what? Choice? I think there’s good reason why this is the dichotomy still used to understand addiction. But there’s even ANOTHER way of looking at it that I’ve recently been mulling over: neurodiversity. So… the term comes from (as far as I know) the autism advocacy movement. The simplified version being that people have different neuro-profiles and some are more typical than others. And we may need the whole range of whackiness for evolutionary reasons. But if we took that perspective into addiction, we could say that some people are more vulnerable to addictions than others and some are more satisfied/gratified/satiated by what those sources of addiction may confer. And if we take it a little further, just like the autism folks, we may not want to call addiction a disease for which we want to search for a “cure” so much as a “vulnerability” or “disability” (albeit perhaps less biologically based) to find a way to support/understand those who are more neuro-atypical in this way. We may want to get why some are more vulnerable than others. And we may want to understand the conditions under which some are more susceptible to certain triggers and less to others. Point being that if we call it a “disease”, there’s a whole lot of resources, money and energy that gets spent on finding a cause and cure. If we think more in terms of disability or vulnerability, we think more about how to create conditions that are supportive, facilitative, and potentially healing (not so much “curative”).
There are major implications to the idea of neurodiversity for understanding addiction. Is it an illness, or is it a result of biological diversity that has other functions — beside the urge to get loaded, purge, or otherwise rapidly transform what we perceive and feel. In fact, the topic is so interesting and important, that the reply I’ve been trying to write is turning into my next blogpost. Look ahead two posts to one dated May 3rd or 4th. It’s about ADHD and migration, and how the disease category is ENTIRELY context-based when it comes to psychological conditions such as addiction.
Wow, hot topic.
Dr Lewis’ concludes that the 4 (now 5) addiction models clash. I don’t think that is correct, perhaps because it is based upon anecdotel evidence….his own experience (drug X works because when I took it, it worked…).
I think that many things we consume, drugs, alcohol, food, can cause obsessive/compulsive consumption. I consumed X because of anxiety, caused by emotional trauma (or not), it seemed to relieve my anxiety, so I learned to consume more and more for relief….the beginnings of brain “disease”.
As I continued, other diseases of other body organs developed…liver disease, gastrointestinal disease, heart disease, diabetes…….after a while, those diseases became irreversible, even after my brain disease was “cured”, or I stopped the compulsive consumption. Choises, caused by traumatic events, or not, accelerated by certain genetic predispositions, or not, progressing (rapidly or slowly) to wide spread disease.
Don’t all of these models actually fit together? Why do we have to pick one. Isn’t the cure for Type II diabetes the same as the cure for alcohol (or food) induced cirrhosis, Addiction is progressive. As Dr Lewis recommends, nip it in the bud, avoid cues, treat the mental illness before irreversible organ disease is established.
My true believe (based on my own anecdotal evidence) is that Dr Lewis has added a new element to the body of knowledge necessary to advance treatment of the progressive mental disorder/disease of addiction, and hopefully a treatment model that can somehow be applied early in the brain disease/disorder progression, before other organ diseases become irreversible.
I also believe that Dr Lewis’ own experiences must have accelerated the elucidation of his model. Not many addicts can recover and then be in a position to advance their “corrupted” learning into constructive learning. His is an incredible, unique and remarkable story, not easily dismissed by any scientist or scientific model.
Thanks again Dr Lewis.
Peter
Thank you, Peter. For sure, my own addiction has informed my views on addiction and the brain. As far as the disease issue, I can’t pinpoint a time when I went from pursuing my impulses, escaping the consequences, and trying to make it all work, to a time when I had anything I could label as a disease. Maybe I’m too close to see it. Maybe that’s a good reason NOT to try to link science and personal experience. I’m sure some would say: look, you did that, and that happened, and then you did it again?! How could that not be a disease?
And yet I want to analyze addiction — with all it’s dark destructive aspects — without needing the disease model as an intermediary. What if we can achieve a really useful and precise analysis without introducing that value-laden term?
In fact, I DON’T think depression is a disease. Like addiction, I think it’s a natural process that’s gone off the rails, precisely because, like addiction, it is self-perpetuating.
Marc:
I think that your personal experience enhances your qualification to examine the evidence, so no, I do not think one should exclude himself from the science because of personal experience.
Dang, now you’ve got me thinking again…..
I think the disease (or not) debate is circular. It’s a matter of semantics. The disease model is self limiting to treatment approaches.
I agree completely that a new model could serve much better.
The natural, corrupted learning model makes much more sense to me, and I think, is less objectionable to common sense than the disease model.
I never would have drawn the connection to depression, but now, yes, I can see the similarities to addiction.
Is Eureka and approriate word here??
Peter
Yes, maybe Eureka. But at least Stay Tuned!
Hmm … here’s another angle on depression. I was a very premature infant who had no suckle instinct, whose lungs couldn’t initially breathe on their own, who did not bond with her mother. One consequence: lifelong major depression — which in my case, I now understand (thanks to a wonderful physician, lots of research, reading, writing, and thinking) as a functional disorder, based on breakage at the beginning of my life — one doc referred to it as ‘brain-stem depression’; another as ‘autonomic dysregulation.’ Seems the template was laid in place before anyone could understand it or do anything about it. Was/is this a disease? I want to say yes; I want to say no; I want to say in part. Ditto addiction. How, Marc, do you see both depression and addiction as ‘self-perpetuating’? What processes perpetuate?
In simplifying the disease model for many to understand, is in saying (Dis-ease) meaning while under the influence of any mind altering substance, your mind is not
(At-ease). therefore someone who is dependant like I was with cocaine, or alcohol my mind was always (dis-eased) by that substance that was in my everyday life. The influence that the drug or alcohol had on my decision making was not of a normal functioning brain, I was in capable of making responsible decisions.So i feel like any other disease of the brain, that while the addict is under the influence or even on the road to recovery, the brain is still (Dis-eased) until such time ration thinking is restored. This is only my view and in saying so, with continued use of the drug or alcohol the brain stays diseased like any other disease without treatment it progressively gets worse and you will succumb to what I like to call a “Dead Head” of society.
Thanks Marc
Reg, Richard
Thanks, Richard. That is a simple, straightforward way for people to think about the definition of “disease”. And it’s true that, without treatment, addiction usually does get worse — though not always — much like many medical diseases.