Addiction is Not a Disease: A Neuroscientist Challenges Traditional Views Part II
Part one of Anne Fletcher’s informative interview with Marc Lewis, Ph.D.revealed why this renowned neuroscientist does not subscribe to the notion that alcohol and other drug addictions are diseases.
In part two, Dr. Lewis expounds on his theory that the way to heal addiction is to wait until someone is ready to change and possesses the desire to do so.
Q: You note in the book that you think the word “recovery” is “ill-founded” because of its medical connotations and then raise a really interesting question: “Why should we call it ‘recovery’ if it’s the beginning of something new?” What would you propose instead?
A: In my chapter “Johnny Needs a Drink,” I discuss how, with addiction, grey matter volume (the stuff of neurons and their synapses) can decrease by as much as 20 percent in the prefrontal cortex with several years of heavy addiction. However, within 6 to 12 months of abstinence, the volume of grey matter goes back to normal and then can increase beyond the normal baseline.
Addicts experience something breathtaking when they can stretch their vision of themselves from the immediate present back to the past that shaped them and forward to a future that’s attainable and satisfying.-Marc Lewis
This makes sense because abstinence requires sustained cognitive effort, which may require new or extended synaptic networks. So instead of “recovery” or “in recovery,” I’d say a better term is “moving forward.” But I want to be clear that I respect the use of “recovery” or “in recovery” in the common parlance of the addiction community. It has come to mean something important to people.
Q: I think one of the most poignant quotes in your book is, “In addiction, the relentless preoccupation with immediate rewards carves a small burrow out of the potential richness of time.”
You also talk about how none of the evidence-based approaches that we use to treat addiction “fully grasps the way time collapses in addiction, nor the critical importance of reframing the links between past, present, and future.”
Tell us what you mean by this and what implications it has for treatment.
A: Addiction involves the powerful phenomenon of “now appeal” – an exaggerated focus on immediate rewards – as well as “ego fatigue,” which occurs when people lose the capacity for self-control after prolonged efforts to battle their impulses. As a result, frustration builds up and letting go just becomes more attractive: they give in to the impulse and dive into whatever is immediately available. So they need help breaking out of the vortex of the present tense.
Both these phenomena are potentiated by the neural changes that go with addiction. However, they are perfectly normal psychological tendencies that can be observed in all humans and even in other animals.
Having lost the capacity to stretch their perspective and their vision to their future selves, people in addiction lose power to control recurrent bursts of craving.
They cannot shift their perspective to an extended sense of self, and effortful suppression just doesn’t work for long.
I think the way to heal addiction is to wait until someone is really ready, thus stoking the desire engines driving one toward that goal, and then helping them connect the sense of their past (for instance, how they got to the place they’re in and to forgive and accept who they are) with a sense of the future and who they want to become. That’s how to break out of the vortex of the present tense.
Q: You say that traditional addiction treatment interferes with this type of treatment. Why?
A: Addiction can only be beaten by the alignment of desire with future-oriented goals set by the individual with the problem.
What will work best is whatever is available when the synaptic avenues of desire make contact with brain regions responsible for perspective change.-Marc Lewis
However, by classifying them as patients, traditional treatment centers often erode the self-direction and self-determination people needed just to get them to commit to treatment in the first place.
And traditional treatment isn’t always available when people are ready to quit. Most important, traditional treatment tends to be uni-size, but there is no one approach, organization, or philosophy that meets everyone’s needs.
Q: Tell us about the inspiring model of treatment you learned about in a British community.
A: This radical treatment initiative was founded by my friend Peter Sheath under the auspices of Reach Out Recovery (ROR) in the city of Birmingham.
The program’s intent is for help to be available at everyday places at the very moment someone’s desire for change is ignited. So places like bakeries, butchers, news agencies, and pharmacies display an ROR sticker on their front windows.
Trained shopkeepers at these locations do brief interventions for addiction so that if someone comes in to buy something and says, “I’ve had it, I’m ready to quit!” they can do a quick inventory and advise on what to do next. Some people are referred to peer mentors who can take things to the next level, and physicians are available for those who need medical care.
But it also rides on the insight that addicts aren’t diseased 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.
Marc Lewis, Ph.D.
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