Pubdate: Sat, 22 Aug 2015
Source: Age, The (Australia)
Copyright: 2015 The Age Company Ltd
Author: Jenny Valentish


Marc Lewis Argues That Addiction Is the Result of ' Deep Learning', 
Probably Triggered by Stress or Alienation. It Can Duly Be 
Unlearned... Via Better Habits


For a long time, Marc Lewis felt a body blow of shame whenever he 
remembered that night. " We thought you were dead," accused one of 
his mates, leaning over him. Lewis was slumped half-naked in a 
bathtub. " We were just talking about what to do with the body."

Lewis was at only the beginning of his odyssey into opiates. After 
this overdose, he dropped out of university and didn't pick up his 
studies for another nine years. At the next attempt, he was excelling 
at clinical psychology when he made front page news. He'd been busted 
raiding a pharmacy for goodies, hopefully Demerol or Methedrine. That 
was careless; he'd been successfully pulling off three or four break- 
ins a week.

That was 34 years ago. Now 64, Professor Marc Lewis is a 
developmental neuroscientist, based at the Radboud University in 
Nijmegen in the Netherlands. He details his early exploits in 2011' s 
Memoirs of an Addicted Brain. His new book, The Biology of Desire: 
Why Addiction Is Not a Disease, cements his image as a rock star of 
neuroscience by loudly challenging the status quo.

The prevalent theory in the United States, and to some degree in 
Australia, is that addiction is a chronic brain disease - a 
progressive, incurable condition kept at bay only by fearful 
abstinence. There are variations of this disease model, one of which 
became the basis of 12- step recovery and the touchstone of most 
rehab programs.

Lewis argues that addiction - or dependence, as we would call it in 
Australia - is the result of "deep learning", probably triggered by 
stress or alienation. It can duly be unlearned by forging stronger 
synaptic pathways via better habits.

The implication for the $ 35 billion treatment industry in the US is 
that tackling addiction as a medical issue should be only a small 
element of a more holistic approach.

The problem is, there's a lot of vested interest - and financial 
investment - in perpetuating the disease model.

There's consensus on the science, at least. As Lewis explains to The 
Saturday Age, repeated alcohol and drug use causes tangible changes 
in the brain. " We all agree on that," he says. " The changes are in 
the actual circuitry, within the synapses that connect the striatum 
to other parts.

" The longer a time that you spend in your addictive state, the more 
the cues attached to your drug or drink of choice is going to turn on 
the dopamine system," Lewis says. At the same time as the release of 
dopamine, nicknamed the feel-good chemical, is being ramped up, there 
is decreased activity in areas of the brain responsible for judgment 
and decision-making.

According to the globally influential US- based National Institute of 
Drug Abuse ( NIDA), these neurobiological changes are evidence of 
brain disease. Lewis disagrees. Such changes, he argues, are induced 
by any goal-orientated activity that becomes all-consuming, such as 
gambling, sex addiction, internet gaming, learning a new language or 
instrument, and by powerfully valenced activities such as falling in 
love or religious conversion. And while the American Medical 
Association may have classified alcoholism as a disease in 1956 and 
obesity in 2013, it hasn't gone so far as to similarly smote love or 

While the disease concept suggests that a person who has become 
abstinent will be in perilous remission forever, Lewis argues that 
new habits can overwrite old. " People have to really be ready, 
because there has to be a powerful surge towards other goals," says 
Lewis. " Goals about their relationships and feeling whole, connected 
and under control. The striatum is highly activated and looking for 
those other goals to connect with."

Lewis certainly isn't the first scientist to believe that " most 
people who become addicted are experiencing some kind of loneliness, 
depression or alienation". He cites psychologist Stanton Peele - who 
has tablet-humped the idea since the 1970s that addiction is a 
learned behaviour influenced by personal suffering - and 
neuropsychopharmacologist Carl Hart.

What's undeniable is that the disease concept they reject is deeply 
embedded into our culture, largely through Alcoholics Anonymous.

Lewis doesn't entirely discredit AA - which in Australia has close to 
20,000 members - but he does suggest that while 12- step recovery 
"works for some addicts, it does so by promoting a kind of PTSD".

As for rehab, he concedes that medicine needs to be there as an 
adjunct for those transitioning through withdrawal and maintenance 
periods, " but you don't need to go to a rehab centre that costs $ 
50,000 a month because it's got medical care that turns out to be 
bullshit, diluted by 12- step meetings, group meetings and equine therapy.

" It's really a fraud," he says, " when there are better ways, such 
as outpatient rehab."

Professor Steve Allsop, from Curtin University, is concerned that the 
disease model over-simplifies drug and alcohol problems with one- 
sizefits- all assessment and treatment. As director of the National 
Drug Research Institute ( NDRI), based in Perth, he's instrumental in 
the policies of the more multifaceted public health model in 
Australia. This model advocates harm-reduction, with abstinence at 
one end of the spectrum.

" I'm not suggesting anything goes," he says. " But some people find 
in-patient care critical, or long-term help in a collegiate community 
such as AA, or are helped by particular pharmacotherapies. No single 
approach has been demonstrated to be ' the way'."

In the US, a person needs to have a definable illness to have 
treatment covered by health insurance, so to have NIDA classify 
addiction as a chronic brain disease facilitates that process.

Professor Suzanne Fraser is the leader of Australia's NDRI's Social 
Studies of Addiction Concepts Research Program and one of the authors 
of the book Habits: Remaking Addiction. She says, " The 
neuroscientific disease approach is heavily promoted by NIDA under 
the leadership of its director, Nora Volkow, who believes that 
calling addiction a disease will reduce stigma.

" It seems Volkow's approach to addiction is in part informed by her 
own experiences of family drug consumption  in The Huffington Post 
she's called her grandfather's alcohol problem a ' disease of free 
will'. Like other researchers, her view is shaped by her personal 
experiences, yet NIDA's research is presented as though it has 
achieved a bias-free viewpoint, from which it can tell us the truth 
of drugs and addiction."

Professor Alison Ritter, director of the Drug Policy Modelling 
Program at the University of NSW says when NIDA first adopted the 
disease model it was to de-stigmatise addiction and, as a medical 
condition, to make it eligible for government funding.

During the 1990s  known as the " decade of the brain" - advancements 
in neuroscience and brain imaging meant " technology caught up with 
the terminology", Ritter says. " There seemed to be a shift from the 
term ' disease' as a rhetorical device to something that Americans 
believed literally. This simplifies dependence down to brain 
chemistry. In reality, it is a complex cultural, social, 
psychological and biological phenomenon."

Ritter predicts fatigue with the brain disease model. " It has not 
produced any new technologies for treatment nor necessarily decreased 
stigma or improved the lot of people who experience dependence 
problems. So in a sense, there is this available space to ask: ' What 
has it been good for, if anything?' "

For now, Lewis is looking forward to hearing about the " 
progressive-sounding" system in Australia when he speaks at the 
Melbourne Writers Festival next week and then at the Festival of 
Dangerous Ideas at the Sydney Opera House in conversation with Johann 
Hari, author of Chasing the Scream: The First and Last Days of the 
War on Drugs. " I agree with his [ Hari's] emphasis on the importance 
of connection," says Lewis. " He says ' the war on drugs' is exactly 
the wrong term and I agree with that, too."

Not all of Lewis' meetings are likely to be so harmonious - he's 
particularly holding out for a pas de deux with the NIDA's Nora Volkow.

" I'm sure there are people out there who think I'm a fraud," Lewis 
laughs, when asked if some researchers might grumble that he is 
biased by his own success story of giving up drugs his way.

" For this new book there were three customer reviews on Amazon 
before it had even come out, giving it one star. These people 
proclaimed that I must be an asshole: ' If Lewis is a scientist then 
I'm an astrophysicist.' They probably think I'm making excuses for 
myself. But I think my credentials are pretty good."

Lewis himself knows that the success of his book is a double-edged 
sword. " I did this talk show in New York and one of the callers was 
pleading with me, ' Don't take this away from us. I need this in 
order to get on with my recovery.' That's pretty heartbreaking for 
me. I don't want to take away from somebody something that's going to 
make them feel better. I just think in the big picture the disease 
model is doing more harm than good."

Professor Marc Lewis appears at Melbourne Writers Festival, Deakin 
Edge, August 30.
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