Rather than being “diseased,” the addicted brain is doing exactly what it was designed to do, but for the wrong reasons. A very readable and accessible explanation of the neuroscience of addiction, that leaves me feeling hopeful about the possibilities for future treatments and recovery.

Neuroscience is readable, comprehensible and makes perfect sense in this book. I am convinced that addiction is not a disease.

In the first chapter Lewis makes a good case against the disease model of addiction. He then spends the rest of the book redundantly hammering his points in. This book was so repetitive that I was ready to toss it across the room.

The stories of the 5 individuals used as examples were interesting and in agreement with his point....but with each example he reiterated his objections to the disease model.

Conversely, he did not go as far as I feel he could have into how, in understanding the role of desire, people could make important life changes.

All together this would have made a great article in a psych publication. There just wasn't enough information there to fill a 200+ pate book.

While I don’t agree with Lewis’ overall argument in the current state of SUD policies and politics, I appreciated many of his points. I thought the balance of neurobiological evidence with individual anecdotes made this book readable and convincing. It will certainly remain on my mind.

This was a great read about the way in which addiction patterns are formed.

This is an absolutely fascinating book. As a mental health professional, I’ve always been a little uncomfortable with the push to identify addiction as a disease. There are clearly benefits to doing so; insurance companies are more likely to offer coverage for medical conditions as opposed to behavioral health conditions, for instance. The disease model also offers relief from stigma and feelings of moral/character failure on the part of the person struggling with addiction, which is often quite helpful in attempting to re-establish health and wellness. Even so, I’ve never felt that “disease” fit quite right, and this book has finally clarified that gut feeling I’ve had for so long.

Marc Lewis is a neuroscientist and he uses his expertise to explore the ways in which our brains are set up to respond to various stimuli, particularly desire, goal pursuit, and restraint. There’s a lot of scientific jargon involved, but Lewis does an excellent job of presenting information in a way that’s mostly digestible to those of us lacking a heavy scientific background.

Essentially, Lewis’s argument boils down to this: Addiction is not a disease. It’s not a disease because the addicted brain is functioning normally, in the way that it was designed to function, in the face of strong desire and goal pursuit. The brain changes that accompany the development of a powerful habit are actually evidence of normal neuroplasticity in response to learning, as opposed to disease or dysfunction. In fact, Lewis points out a number of times that the brain generates identical responses and patterns to all strong desires, be it love, sports, or heroin. Does that mean that love is a disease, too? I think most people would argue that it’s not.

This isn’t to say that addiction is healthy or that we shouldn’t attempt to treat those struggling with it. It also doesn’t suggest inherent character flaws or moral failures on the part of the addicted person. The brain is powerful and once such a strong, established habit is formed, it’s incredibly difficult to change (i.e. the addicted person cannot always “just choose” to stop using; it’s not necessarily a matter of willpower or choice once brain pathways have been laid and buttressed so thoroughly over the course of time).

Like any bad habit, we all know that consequences of addiction can cause a lot of serious damage; physically, psychologically, socially, financially… And for these reasons, it’s important for professionals to recognize addiction for what it is, and to develop models of treatment that honor the fact that the addicted brain isn’t diseased or broken, but working incredibly well and must be effectively redirected to establish healthier habitual pathways in relation to desires, motivations, and goal pursuit.

Interesting stuff, folks. I recommend the read!

I liked this book a lot for it's clear and dispassionate evaluation of theories of addiction that are now being further illuminated by the advances in neuroscience research. It is clearly a good time to evaluate this with so much more information and the ineffectiveness of many treatment programs. The author shows how neuroscience research can support the disease model, but also how this is an incomplete picture. He mentions the positive parts of treatment programs, including AA and NA, along with some of the ways that new work suggests alternatives or changes may increase effectiveness. He allows for genetics, trauma and particular personalities to make certain people more susceptible. He did not just promote his theory in a vacuum. Marc Lewis has the authority to speak to the topic as a former addict and as a Neuroscientist, and the stories he chose to exemplify his points are compelling and help bring them to life.

One of the parts I most enjoyed was the extensive discussion of neural pathways that change in the formation and treatment of addiction. For a non-neuroscientist, there is a lot of science discussed, but at a level that is mostly accessible. If that does not float your boat, you can skim over the details, and get the main points that things change in the brain with addiction, and there are biological reasons for it. I think hearing that with authority will be helpful to many addicts who want treatment but are still struggling. The plasticity of the brain allows humans to become addicted easily with things that are initially highly desirable, but also paves the way for hope, because those neural pathways can be modified over time. No one single, simple solution, but a pathway that can differ for each person fighting with addictions of many types.