agrees that addiction may not be a disease

Or at least they agree that the point is worth considering. Their review of my book is quite positive. Laura Miller, a senior writer for Salon, got most of it right, and she didn’t shy away from the details. Way better than a kick in the head.

A couple of relevant quotes:

One of those neuroscientists is Marc Lewis, a psychologist and former addict himself, also the author of a new book “The Biology of Desire: Why Addiction is Not a Disease.” Lewis’s argument is actually fairly simple: The disease theory, and the science sometimes used to support it, fail to take into account the plasticity of the human brain. Of course, “the brain changes with addiction,” he writes. “But the way it changes has to do with learning and development — not disease.” All significant and repeated experiences change the brain; adaptability and habit are the brain’s secret weapons. The changes wrought by addiction are not, however, permanent, and while they are dangerous, they’re not abnormal. Through a combination of a difficult emotional history, bad luck and the ordinary operations of the brain itself, an addict is someone whose brain has been transformed, but also someone who can be pushed further along the road toward healthy development…

One size does not fit all, and there’s a growing body of evidence that empowering addicts, rather than insisting that they embrace their powerlessness and the impossibility of ever fully shedding their addiction, can be a road to health as well. If addiction is a form of learning gone tragically wrong, it is also possible that it can be unlearned, that the brain’s native changeability can be set back on track. “Addicts aren’t diseased,” Lewis writes, “and they don’t need medical intervention in order to change their lives. What they need is sensitive, intelligent social scaffolding to hold the pieces of their imagined future in place — while they reach toward it.”



38 thoughts on “ agrees that addiction may not be a disease

  1. matt June 30, 2015 at 5:49 pm #

    It is a great review, and much better than a “kick in the head.” I wouldn’t take my helmet off just yet though. This is just the beginning….

    • MSimon October 7, 2018 at 10:27 am #

      Addiction is a symptom of PTSD. You can look it up.

      I’m not going to give a specific link. The knowledge is common.

  2. KC July 1, 2015 at 5:39 am #

    It’s great to see people begin to understand chemical addiction as a type of mislearning, a natural misunderstanding with not so deep chemical hooks when one isn’t using. A much better approach rather than a life-long disease.

    After 7 months clean, the last two months of which are here in Northern California, my addictive behaviors do not feel life-long nor do I feel powerless over anything but certain social structures and institutions (systems).

    Keep you mouth piece in. Keep swinging, After all we are all in the same corner, your corner. The old adage; No shame in getting knocked down, so long as we keep getting back up!


    • Marc July 2, 2015 at 3:46 am #

      Right on. But my loins are girded and my armor fastened. It’s best to go into battle with the knowledge that you’ve got an army on your side somewhere.

      By the way, total non sequitur: A friend of mine took that Necker cube analogy and applied it to a famous 12-step saying: your addiction isn’t doing push-ups in the parking lot — it’s just a couple of microns away in your own brain. Love it.

    • Marc July 2, 2015 at 3:50 am #

      PS, KC: Congratulations are in order. Viewing addiction as a learned (or mislearned) behaviour doesn’t make it easy to shake. Not at all. If it were, jihadism, racism, sexism, and falling hopelessly in love with the wrong person would just be temporary missteps.

  3. Shaun Shelly July 1, 2015 at 6:05 am #

    I absolutely loved this quote of yours: “Addicts aren’t diseased,” Lewis writes, “and they don’t need medical intervention in order to change their lives. What they need is sensitive, intelligent social scaffolding to hold the pieces of their imagined future in place — while they reach toward it.”

    It perfectly summarises everything.

    • Richard Hollett July 1, 2015 at 8:36 am #

      Ditto! Among the massive amounts of misinformation about addiction, it is practically unheard of to come across something that so perfectly captures the essence of addiction, such as this quote. I am chronically agitated when I read about the “disease” of addiction. Then I read Marc’s words and it soothes that agitation – coincidentally, in a way that a drink isn’t even capable of. It brings to mind the unparalleled power of truth.

      • Janet July 4, 2015 at 6:40 am #

        Yes. The truth always has that unmistakable ring to it. AMEN. Bravo. Thank you.

    • Marc July 2, 2015 at 3:52 am #

      Thanks you guys!! It’s not bad, is it. I’m going to use that phrase for publicity from now on….it feels great to stumble on just the right words, and you never know that you’ve done it until you hear back from other people. Seriously, thanks.

  4. Mark July 1, 2015 at 6:59 am #

    Marc, my copy is en route.
    Once I get it and read it, I’ll add
    an Enchanted Loom review of it
    to the Memoirs review already in
    the collection …

    • Marc July 2, 2015 at 4:14 am #

      Thanks for this, Mark. I clicked on the link and read your review of Memoirs. I really appreciate your attention to gist and detail at the same time. I also read your review of Arrowsmith-Young, and I’ll get to Ramachandran next.

      This is a marvelous feature….I recommend it to anyone who wants to take advantage of quick, well-aimed wormholes in the galaxy of information on the misfiring brain.

      By the way, I tried to leave a comment, but the sign-up process was too involved for my tired brain. Basically I didn’t want to give my email address to the middle-man, the slide-share thing, at least not at this moment. You might want to simplify this process.

      • Mark July 2, 2015 at 10:18 am #


        I’ll check and see if I can make Slideshare less cumbersome and intrusive.

        I went and visited one of Barbara Arrowsmith-Young’s schools on the UBC campus in Vancouver. I have to say I was greatly impressed. There’s a lot going on there apart from the technology that she’s using that I have little doubt is positively influencing the results she is reporting. She’s essentially built a sangha around technology for LD and traumatized kids.

        Microsoft has just given her a substantial grant to recreate the UBC experience in Seattle.

        The book is worth a read.

        ~ Mark

  5. Nicolas Ruf July 1, 2015 at 9:27 am #

    The problem is that some learned behaviors get stored permanently and even unconsciously. That’s why you can ride a bicycle even after years of not; and why you can drive in a blackout. Once kindled so the behavior runs out of the dorsal striatum, it manifests as obsessive and compulsive, autonomous, and impervious to control or modification. How else explain the reinstatement of the addiction intact after a period of abstinence? It just lies dormant.

    • Marc July 2, 2015 at 4:22 am #

      Yes and no. Indeed the dorsal striatum can fire off behaviour patterns you haven’t consciously initiated for a long time. But to say these patterns CAN’T be controlled is really stretching it. Whether it’s brushing your teeth or wiping your bum, automatic behaviour sequences CAN be modified (e.g., when you’re rushing to catch a plane)… For that you need to activate the left (?) dorsolateral PFC, providing a moment of reflection to interrupt the sequence. It’s just that that moment of reflection is itself a victim of habitual routines (and the dopamine detour)… So you lose it and regain it with practice. Practice, practice, practice…..sounds to me like a learning issue.

    • matt July 2, 2015 at 6:00 am #

      …and try driving after you haven’t done it for a year or two. It’s scary! You really notice, at least momentarily, the complex coordination and interaction of the different systems involved, until the old pathways kick in. That’s the space where you can do something about the addictive behavior— that space before the old pathways light up. It’s brief but it’s there. If you can pause long enough to engage a counteractive behavior to distract yourself, you can modify the habitual behavior. But as Marc said, it takes practice, practice and more practice. I had to learn to notice the urge or trigger— pause, and then do something different— A LOT!

      • Nicolas Ruf July 2, 2015 at 8:23 am #

        Absolutely. As Leonard Cohen says, “There’s a crack in everything; that’s how the light gets in”.

        • Mandala October 12, 2015 at 7:40 pm #

          I love that quote! Thank you for sharing.

  6. William Abbott July 1, 2015 at 10:45 am #

    I have been fortunate enough to have read it. It is a winner and I consider it a “must” read for anyone interested in the subject of how and why we have this and thereby can get rid of it ( recover is the term -which i avoid using but thats another story)

    As I told Marc privately , he “nailed ” it .. or nearly so 🙂

    • Marc July 2, 2015 at 4:22 am #

      Thanks so much!

  7. Joy Koesten July 1, 2015 at 12:33 pm #

    My question is this…. how does one shift the thinking of an addict who is doing well in recovery (through the 12-step program and other means) that this new thinking might empower them? Seems it would pull the rug out from under them – shifting the way they think about their addiction. Comments? Insights?

    • Guy Lamunyon July 1, 2015 at 12:53 pm #

      Why pull the rug out? if they are doing well leave it alone! If the person is ready for DEPROGRAMMING there are plenty of resources (Orange Papers, Stanton Peele’s website, Cult or Cure – Buffe and others).

      • Joy K July 1, 2015 at 10:41 pm #

        Thank you for your thoughtful and kind reply. I so appreciate you feedback.

    • Richard Hollett July 1, 2015 at 7:32 pm #

      Joy, You raise an important and delicate question. My feeling is that any “addict” who abstains from drugs/alcohol is doing so by their own choice – even those who forfeit the credit and instead attribute their success to a specific treatment program – 12 step or otherwise. If they are doing well, then why try to shift their thinking? The most healing benefits of expanding perspectives beyond a “one-size-fits-all” perspective is to prompt a universal acceptance of remedies/philosophies outside of – and in addition to – conventional/12 step programs – not to dismiss or discredit those programs for those who seem to find comfort or strength in them. It is my personal belief that there are universal truths that we are all ultimately guided by. At the same time there are as many paths that lead to those truths as there are people on this planet. If part of someone’s path is to experience the 12 step philosophy – or even just experience the comfort, support, familiarity they find by attending meetings, then who am I to determine where that will lead. It is not for me to conclude that he or she is on the “wrong path”. While I am not at all compatible with the 12 step philosophy, the meetings are attended by men and women who deserve (and have) my support and best wishes for a beautiful and fulfilling life. I personally do my best to place that above any urge to validate my own beliefs – one of those beliefs being that if I am confronted with an opportunity to be right or be kind – I choose kindness. Hope my answer contributes something to your valid concern.

      • Joy K July 1, 2015 at 10:40 pm #

        Thank you for your thoughtful and kind reply. I so appreciate you feedback.

      • matt July 2, 2015 at 10:28 am #

        What he said.

        Nobody knows the right path for you…except you.
        Addiction obfuscates, maybe takes a detour here and there, but it is still your path. And it has always been there…
        The process of recovery– of rediscovery– helps clarify that truth, and sharpen the focus of the path.

        Hey! “Rediscovery” rather than “recovery”?
        Naah…it’d scare the straights

    • matt July 1, 2015 at 9:32 pm #

      They are not in opposition. The motivational learning, the new habit learning, the model…they all fit the underpinnings of all successful approaches..
      Those who get the rug pulled out from under them are unsteady in their sobriety

      • Joy K July 1, 2015 at 10:42 pm #

        Thank you for your thoughtful and kind reply. I really appreciate your point of view.

    • Marc July 2, 2015 at 3:42 am #

      You guys are great. You make this blog truly interactive and you come up with some seriously wise words in the process. A real help not only to Joy but to all other readers as well.

      Did I just say “seriously wise”?

    • William Abbott July 2, 2015 at 9:09 am #

      This is a great question and a similar reply to Guy. Many succeed in recovery using a combo of both approaches– picking what works for you and leaving the rest. A policy seen in both AA and Smart

      Worked for me– its just the foundation of Smart that resonates with me better- self empowerment

  8. cheryl July 1, 2015 at 1:52 pm #

    Read the review, ordered the book and am so excited to read it. I love the wholeness of its essence in moving forward and away from some old and damaging responses to a disruptive habit. Thank you

  9. Marcus July 1, 2015 at 3:46 pm #

    I tried to write response on Salon, but it wasn’t posted. While I agree that addiction is not a disease, I do so for very different reasons. In my view, addiction cant be a disease by definition. However, there are a certain sub-pop born with a reward cascade that doesn’t function normally driving them to always be looking to elevate their “feel ok” system. This is what the disease is, and is what is driving those ppl (say 10% of the population) to use addictors (substances, behaviors, beliefs) in a way that only they can, the rest can use with impunity. So, addiction is a SYMPTOM of brain disease, as is decision making disasters & evaluation mistakes of self & others. All 3 symptoms are driven by the diseased reward system. I respectfully disagree with Mark on this one.

    • Marc July 2, 2015 at 3:41 am #

      Marcus, I’m not so sure about that. You are describing Blum’s reward deficiency syndrome, right? And he traces this tendency to a particular allele (variant) of the gene that manufactures dopamine receptors. These folks may indeed have a genetic disadvantage, but that’s far from a disease.

      I actually know a guy who experiences rewards in a sort of blunted way. But he never became an addict. And I’m the opposite: I get all hot and excited about even minimal rewards, but I did become an addict anyway.

      Genetic predispositions are just that: predispositions. The outcome, addiction or not, is where we need to focus our definitional concerns, whether we call it a disease or not.

      • Marcus July 2, 2015 at 10:38 am #

        K Blum’s “Reward Deficiency Syndrome” was flawed in many ways, not the least of which was a mono genetic premise for the whole hypoth (think its pretty clear its polygenetic disease). I’m not sure about your friend or you, but those would be just 2 cases which is insufficient for a determination of validity. Addictability or the vulnerability to… which involves a bell curve of severity, is what I believe will one day be proven and genetics will be the sole cause. I also don’t think its just a liability, there are many positives as well. Yet behaviors aren’t inherited, the mechanisms for the ability either are or are not. I don’t believe you can unlearn genetics, but you can learn to live with what you were born with. Like Prader Willi is no longer considered the “disease of over eating” as it was for many years (behavior), its now recognized as a purely genetic disease (Leptin).

        • Richard Hollett July 2, 2015 at 10:50 pm #

          Marcus, if you can learn to live with what you are born with – meaning choose the ways to express your genetic self, isn’t that an indication that behaviors (ie addictive) are at least in part, learned? If someone who has a genetic leaning toward addiction ended up struggling with alcohol then stopped by learning new, healthy behaviors that no longer includes alcohol, isn’t that an indication that he must have first learned the wrong way? In other words, some influences must have existed for that gene to express itself as a “liability” in the first place, rather than as something positive.

          A person’s environmental influences, which are especially powerful during early childhood years do contribute to the way a person behaves and expresses his “genetic self”. Seems to me that there are people who have genetic leanings toward addiction who never struggle with drugs or alcohol – and those who end up struggling with drugs and/or alcohol who don’t have a genetic leaning toward addiction. I would personally be very skeptical of any scientific findings that suggests genetics is the “sole cause” of addiction. My real life experiences present far too much evidence to the contrary. For me personally to have been told (and accepted) that genetics is the sole cause of my struggles with alcohol would have robbed me of my solution, which came about by specifically understanding all components of myself – circumstances, relationships, self-perspectives, influences, emotions, beliefs, desires, goals, and so on.

          There is a lot of information about addiction today – and more continues to be discovered and promoted. It’s cool to understand Science’s spin on it, but it speaks more of theories and the commonalities of addiction, which isn’t necessarily where the “bulls-eye” solution is found for any given individual. I personally believe that is because the authentic solution can be found in only one place – within the very unique mind/ perspective/story of the individual who struggles. In order for the addiction-chapter of a person’s life story to be successfully rewritten, the story has to be known and understood in its entirety.

          • Marc July 3, 2015 at 5:20 am #

            I strongly agree with you, Richard, but would even go one further. One of my favourite lines comes from Steven Pinker: You say that genes and environment interact to produce behaviour? (that’s the current trend).. That’s like saying that your CD player and your CD interact to produce music. They don’t interact because they are not two things: They are one system. Genes are always constrained, transformed, and expressed through their environments. They don’t have any meaning in themselves.

            • Marcus July 4, 2015 at 3:34 pm #

              After rereading my post, I think I came across as more of a genetic determinist than I actually am. I’m open to addiction causation theories yet do tend to believe genetics is down played for the most part when it comes to their role in this. I’m really enjoying learning about the different ways people view addiction causation, aside from the “your just an asshole and that’s what assholes do” approach. I am certainly no expert. I’m interested in epi-genetics too and wonder if that has a role. I haven’t read Marc’s new book but one question I have going in to it is what makes certain people “learn” addiction differently than others? It’s almost like certain people have a “limbic wind” driving motivation than others just lack.

            • Aislinn October 14, 2015 at 3:36 pm #

              Brilliant! This quote is the perfect comeback for people who simplify things down to “oh, it’s just genetic”.

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