An important addition to understanding addiction.

This book offers enlightenment and intellectual understanding of addiction on several levels. The science was fascinating, the writing lucid, the stories compelling and the conclusions sound. As a now sober alcoholic who lost my mother and an uncle to liver disease, I know the horrible grip and terrible cost of addiction. This book takes a fair, clear minded look at the value and costs of the disease model. As such, it is not only valuable to the addict who travels their own healing journey, but to professionals in the field as well. It is time to point out with strength of conviction that the Emperor, if not lacking clothes entirely, is poorly dressed . I am hopeful this book will make healing more accessible to those who are not yet desperate enough for the dogma and theology of AA. Don't get me wrong, I credit AA with saving my life and helping me break the cycle of addiction for my family. This is miraculous praise indeed. But it is time for the next evolution into a more sophisticated and rationale treatment regimen based on neuro science and psychology. This book is an important contribution to that future and perhaps even prescient of where we are headed.

18 people found this helpful

Interesting concept good narration

Neuroscientist and former addict Marc Lewis writes an engaging study of the biological changes that occur in an addicted brain, complete with personal stories about himself and several addicts that he interviewed. Lewis points out that there are two major models for addiction - the disease model and the choice model - and argues why he believes the disease model has outlived its use and is now harming rather than helping addicts.

The disease model of addiction is highly accepted by clinicians, psychologists, and insurance companies right now. It posits that the more an addict uses a substance, the more his brain changes, and the more he needs the drug. Furthermore, some people have a biological preinclination for addiction - it doesn't mean that they will become addicts, but the genetic preinclination raises their chance of becoming an addict under the right environmental stimulus. The combination of genetic factors and changes in the brain suggest to clinicians that addiction is a disease. A lot of money, therapy, and medication currently goes into treating addiction as a disease - often successfully.

Lewis argues, though, that changes in the brain and genetic preinclination do-not-a-disease-make. After all, every experience changes your brain - and some events, like falling in love, change your brain in much the same way addiction changes it. Furthermore, much as people have a preinclination for addiction, they also have a preinclination to temperament. For instance, an introverted, agreeable parent is more likely to have an introverted, agreeable child. Despite this heritability, temperament is not considered a disease. So why do we pick-and-choose which heritable brain-changing habits are a disease?

My answer is that addiction is considered a disease whereas in-love and temperament are not considered diseases because in-love and temperament do not generally cause clinically significant impairment in an individual's ability to function in the workplace and social interactions. And when they do inhibit the individual's ability to function, then they are considered a disease.

Instead of the disease model, Lewis supports the "choice" model. People choose to abuse substances in the first place, and continue to make that choice. And when they give up the substance abuse, it is generally because they have chosen that now is the right time to give it up.

Lewis spends the great part of this book describing why he feels viewing addiction as a disease is harmful to addicts as well as unhelpful for treatment. When an addict views his problem as a disease, then he might feel helpless to make his situation better. Whereas if he views it as a choice, he recognizes that he has power over this problem. You might notice that this is in stark contrast to the first step of AA in which the addict accepts that he is powerless over his addiction. In fact, in the stories of Lewis' interviewees, none of them mentioned AA or NA as a helpful tool for stopping their addiction.

Lewis also points out that although medication and therapy generally help the individual to give up alcohol to begin with, there is a very high relapse rate. And that is because although the individual doesn't want the negative effects of his addiction, he has not yet accepted the choice to give up the drug.

Lewis claims that many people view the choice model and the disease model as mutually exclusive, but he believes that they are not. I would tend to agree with him on this. I don't see the harm in viewing addiction as a disease - in fact, I think this model would be very helpful to a certain subset of addicts - it provides them a reason to say "this is not my fault, I have a disease, and I need to live as healthy a life as I can in order to not let it ruin my life." But I also think the choice model is helpful to another subset of addicts - it provides them the ability to say "I have the power to choose not to use. I am not powerless."

14 people found this helpful

only explanation I've ever read that made sense

I have struggled with, and overcome, several addictions. This model of thinking about addiction is the only one that explains my experience and my eventual freedom. Happily my one remaining addiction is over eating, and this book helps make sense of what I need to do to move forward.

13 people found this helpful

Slow to come together, but ultimately earth-shattering

I’m an addict in long term recovery (in conventional terms), and a Master’s student in Addictions Counseling. I am pretty well-versed in etiology of mental illness and brain disorders, sociology, psychology, and Special Education teaching (formerly LD/DD/EBD, & PHD). I alternated between reading the book and listening to this audio version. I found understanding the technical subject matter and connecting it to the personal stories more difficult than most of the books and texts I’ve used in the past, including the most medical, least subjective case studies. The statements in the book were sometimes contradictory, and some of the points did not follow the premises in the book. The audio was even harder to follow, because the delivery was devoid of emphasis on the more important ideas and information. The delivery was dry and monotonous, despite intense subject matter like desire, the intense pull of immediate gratification, and incredible transformations of both matter and perspective. Just when I was about to give up on it entirely, I came to Chapters 8-10, where the book finally begins to take shape. If I had not turned off the rapid-fire, expressionless narration, I might never have noticed that things made more sense from there on out. What followed is what I have been seeking the answers to for years. It’s a full explanation of how and why a pattern of substance abuse took over my life, how it was able to be arrested, and what it was that finally enabled me to quit using addictive substances and return to a life of meaning, even more so than before my fall. It gives concrete and inspiring information I can use in my future career, one I feel far more likely to remain focused on, for having read it. I think the premises and the thesis statement could have been set up better in the beginning, as well as a list of basic terms and the diagrams included throughout. Most people I know who are assigned, or choose to read, this book do not have the necessary background to keep up, particularly not with the rapid and low-interest reading style. I think a lot of the problem is that the subject matter is insufficiently introduced, because I usually don’t have a hard time keeping up. Despite the plodding, disjointed start, the conclusions in chapters 7-10 are major breakthroughs. I wish the narration matched the excitement of the book’s incredible conclusions. I see myself in the mental processes and life processes described. Essential to understanding addiction if you work with, create policy affecting, judge, or think you care about people with addiction. I recommend this to anyone who is, or has a friend, family member, or knows anyone facing addiction. However, I wish I had read the last three chapters first.

10 people found this helpful

If you use headphones, don’t.

I love this book, subject and author.

How did Mr. Whistles His S’s ever get a job as a book reader, I don’t know. Couldn’t that somehow be edited out?

It hurrrrrrts.

9 people found this helpful

Awesome indepth look at neurology of desire

Any additional comments?

I have been learning for years about the stunning advances in understanding how the brain works, for example, learning how the brain is influenced by emotional trauma and then creates extreme reactions (PTSD) That's important and good to know. But the research and synthesis presented in this book is what I've been waiting for, an explanation of the drives and compulsions that seem to be stronger than willpower. We all have them. Too much food. Nah, I don't feel like going to the gym. And then of course there are the serious addictions that are ripping up society. This book breaks down the biology of desire in a way that is understandable to the well informed person who is interested in trying to make sense of the important workings of the gray blob behind our eyes. I loved the way he detailed the pathways of thought that interrupt and oversee impulses. One of the best takeaways was the breakdown of desire into its seeking component and the actual pleasure - and how nature has much more interest in getting us to do the seeking (it's easy to see this in addictions - that the seeking behavior takes over the mind with an almost violent control - just as nature would want), and his ending with a call toi mproving one's narrative, showing off the new hidden-but-gradually-becoming-better-respected method of Story that is needed by the prefrontal cortex in order to keep reins over desires.

8 people found this helpful

Should be the neuroanatomy of desire

The information stimulated my striatum, traveled to my orbitofrontal complex, fermented in my prefrontal complex, then took the long voyage via the stercorotaural pathways to my celiac plexus, initiating a migrating motor complex. Then the author presented his opinions on addiction.

5 people found this helpful

even better than I expected

stories this book in an especially interesting listen and understand. the technical understanding of the brain is working substrate forbid formidable and types but the overall hope and info display for phone

3 people found this helpful

Great read for any thinking person!

Wow, very interesting explanations on how people think and how addictive tendencies are just part of human behavior. On that note alone it's a good read, however if your dealing with someone who is an addict of any sort this book really helps in understanding why they act the way they do.

3 people found this helpful

Hope for the future?

Very helpful for gaining a better understanding of myself and my struggles. I now have the insight, just need perspective.

3 people found this helpful