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Praise for the Biology of Desire by Marc Lewis PRAISE FOR THE BIOLOGY OF DESIRE BY MARC LEWIS "The Biology of Desire says a lot about the brain mechanisms underpinning addiction but, to its credit, does not stop there. With minor exceptions, we do not help addicts (and they do not help themselves) by ministering di- rectly to their brains.... Lewis stresses throughout this unorthodox but enlightening book [that] people learn to be addicts, and, with effort, they can learn not to be addicts, too." — Wall Street Journal "Wonderfully readable ... and accessible in the descriptions of compli- cated brain science.... One finishes The Biology of Desire with a greater... appreciation for the argument that we may be thinking about addiction all wrong." —Washington Post "Marc Lewis offers a unique perspective on how addiction is seen through the famously misleading distinction between nature and nurture, as though it must be one or the other, when in fact, like most aspects of human life, it is inextricably both." —National Post "Neuroscientist Lewis delves into the functioning of the addicted brain. He intends to demonstrate that addiction (substance abuse but also be- havioral addictions such as eating disorders, gambling, etc.) is not a disease.... This objective is met by the detailed life stories of five recov- ering addicts the author has interviewed. Their descent into the grips of addiction reads like passages of a junkie's memoir: terrifying and page- turning.... This work helps make sense of how addiction operates and is recommended for readers wanting to learn more on the topic." —Library Journal "Informed by unparalleled neuroscientific insight and written with his usual flair, Marc Lewis ... 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, MD, author of In the Realm of Hungry Ghosts: Close Encounters with Addiction "So much nonsense is spoken about addiction and the brain. If you want to understand what's really happening, read Marc Lewis' clear, insightful, and necessary book:' —Johann Hari, author of Chasing the Scream "Armed with scientific data and plenty of case studies ... Lewis enters the ongoing addiction nomenclature debate with an intellectually au- thoritative gyet controversial declaration that substance and behavioral dependencies are swiftly and deeply learned via the `neural circuitry of de- sire:... Lewis introduces biographical testimonies of [people] struggling with addiction that both humanize and reinforce his standpoint.... A thought-provoking, industry-minded, and polarizing perspective on the neurocircuitry of human desire and compulsion:' —Kirkus Reviews "Neuroscientist Lewis (Memoirs of an Addicted Brain) presents a strong argument against the disease model of addiction, which is currently pre- dominant in medicine and popular culture alike, and bolsters it with infor- mative and engaging narratives of addicts' lives ... Even when presenting more technical information, Lewis shows a keen ability to put a human face on the most groundbreaking research into addiction. Likewise, he manages to make complex findings and theories both comprehensible and interesting ... [T]his book, written with hopeful sincerity, will intrigue both those who accept its thesis and those who do not:' —Publishers Weekly "If you want to understand addiction—and why it matters how the brain actually learns to become addicted—read this book. In elegant and inci- sive prose, Marc Lewis expertly explains the neuroscience of desire, and how it shapes the paths of our lives:' —Maia Szalavitz, author of Unbroken Brain "A very readable, often touching, gateway into the universe of neurosci- ence and the shadowland of addiction:' —Sydney Morning Herald "Highly readable and plausible illustration of current ideas about addic- tion from behavioural neuroscience and clinical perspectives by the use of vivid case histories:' —Trevor Robbins, Professor of Cognitive Neuroscience and Experimental Psychology, Cambridge University "Dr. Lewis—a former addict who recovered to become a distinguished neuroscientist and author—writes engagingly about the addictive experi- ence, the recovery experience and the science behind them. Whether you are looking for a foundation in the neuroscience of addiction, guidelines for recovery or just hope that recovery is possible, it's all here.... Informed by this book, you'll see how neuroscience explains addiction as a part of life, rather than a mysterious entity only experts can understand:' —Tom Horvath, Ph.D., President of Practical Recovery, SMART Recovery, and author of Sex, Drugs, Gambling & Chocolate: A Workbook for Overcoming Addictions "Marc Lewis's new book neatly links current thinking about addiction with neuroscience theory and artfully selected biographies. Ex-addicts, we learn, are not `cured, rather they have become more connected to others, wiser, and more in touch with their own humanity. This is a hope- ful message that has, as Lewis demonstrates, the advantage of also being true:' —Gene Heyman, author of Addiction: A Disorder of Choice "[B]y embracing neuroscience whilst rejecting the notion of addiction as a brain disease, Lewis's conceptualization has the potential to radically change the way that addiction is viewed by clinicians and the general public:' —Matt Field, Professor of Psychological Sciences, University of Liverpool "This is the real story of `this is your brain on drugs; but one that provides a refreshing, convincing alternative to the widespread traditional dis- ease-model view of addiction.. .. Most important, it offers far more positiv- ity about ways out of addiction than those offered by traditional treatment, providing hope for those struggling as well as for their loved ones:' —Anne M. Fletcher, M.S., author of New York Times best-selling Sober for Good, Inside Rehab, and the Thin for Life books, and recipient of the Research Society on Alcoholism Journalism Award and APAs Outstanding Contributions to the Understanding of Addictions Award "A courageous and much-needed voice in rethinking addiction ... This model provides realistic hope, given that what has been learnt can be un- learnt by harnessing the principles of neuroplasticity. Through his intimate personal and professional knowledge of addiction Lewis reframes our un- derstanding of its mechanisms and nature in a way that is empowering:' —Barbara Arrowsmith-Young, author of the international best-seller The Woman Who Changed Her Brain "In his brilliant analysis, Marc Lewis shows that what are supposedly ad- dictive drugs merely replicate the same brain patterns created by engaging and rewarding activities across the life spectrum:' —Stanton Peele, author of Love and Addiction and Recover! the BIOLOGY of DESIRE Why Addiction Is Not a Disease MARC LEWIS PUBLICAFFAIRS New York Copyright © 2015 by Marc Lewis Hardcover first published in 2015 in the United States by PublicAffairs', an imprint of Perseus Books, a division of PBG Publishing, LLC, a subsidiary of Hachette Book Group, Inc. Paperback first published in 2016 by PublicAffairs All rights reserved. Printed in the United States of America. No part of this book may be reproduced in any manner whatsoever without writ- ten permission except in the case of brief quotations embodied in critical articles and reviews. For information, address PublicAffairs, 250 West 57th Street, 15th Floor, New York, NY 10107. PublicAffairs books are available at special discounts for bulk purchases in the US by corporations, institutions, and other organizations. For more information, please contact the Special Markets Department at the Perseus Books Group, 2300 Chestnut Street, Suite 200, Philadelphia, PA 19103, call (800) 810-4145, ext. 5000, or e-mail [email protected]. Book design by Jeff Williams A CIP catalog record is available for this book from the Library of Congress. ISBN 978-1- 61039 -437-6 (hardcover) ISBN 978-1- 61039 -438-3 (e-book) ISBN 978-1- 61039 -712 -4 (paperback) Library of Congress Control Number: 2015940383 10987654321 For the members of my blog community, who have generously shared their experiences and insights, and for the five who trusted me to tell their stories here CONTENTS INTRODUCTION, Xi Chapter One Defining Addiction: A Battleground of Opinions 1 Chapter Two A Brain Designed for Addiction 27 Chapter Three When Craving Comes to Power: Natalie's Story 47 Chapter Four The Tunnel of Attention: Brian's Romance with Meth 71 Chapter Five Donna's Secret Identity 95 Chapter Six Johnny Needs a Drink 117 Chapter Seven Nothing for Alice: The Double-Edged Sword of Self-Control 139 Chapter Eight Biology, Biography, and Addiction 161 Chapter Nine Developing Beyond Addiction 193 ACKNOWLEDGEMENTS, 217 NOTES, 219 INDEX, 225 ix INTRODUCTION Public attention has been riveted by the harm addicts cause them- selves and those around them, more in the last few years than ever before. And the way we view addiction is changing, moulting, and perhaps advancing at the same time. We've begun to separate our ideas about addiction from assumptions about moral failings. We're less likely to dismiss addicts as simply indulgent, spineless, lacking in willpower. It becomes harder to relegate addiction to the down- and-outers, the gaunt-faced youths who shuffle toward our cars at traffic lights. We see that addiction can spring up in anyone's back- yard. It attacks our politicians, our entertainers, our relatives, and often ourselves. It's become
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