Addiction is a puzzling phenomenon. Why do addicts persist in self-destructive behavior even after it has lost them their jobs, their family, their health, and their self-respect? Do they have any control over their behavior? If so, why don’t they control it? If not, why not? Two recent books shed light on these questions: The Biology of Desire: Why Addiction Is Not a Disease, by Marc Lewis, and The Thirteenth Step: Addiction in the Age of Brain Science, by Markus Heilig.
Lewis is a neuroscientist and former addict; Heilig is a physician and addiction researcher. Lewis is convinced that addiction is not a disease, but a habit created by the neural circuitry of desire in the course of its normal functioning. Heilig is convinced that addiction is a chronic disease like diabetes that can’t be cured but that must be managed by lifelong treatment.
While they disagree about whether addiction is a disease, they actually agree about almost everything else. They agree that we should reject the stigma of addiction as a kind of moral failing. They reject the hypotheses that addiction is a matter of choice or self-medication. They think current diagnostic labels are inadequate. They both try to integrate two levels of information: the case histories of addicts and the scientific knowledge from research. They are both skeptical of AA and of conventional rehab programs. They both support evidence-based treatments. They both think addicts are not all alike and that individual addicts will respond better to individualized approaches. (more…)