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!