Written by Anke Snoek
Macquarie University
When neuroscience started to mingle into the debate on addiction and self-control, people aimed to use these insights to cause a paradigm shift in how we judge people struggling with addictions. People with addictions are not morally despicable or weak-willed, they end up addicted because drugs influence the brain in a certain way. Anyone with a brain can become addicted, regardless their morals. The hope was that this realisation would reduce the stigma that surrounds addiction. Unfortunately, the hoped for paradigm shift didn’t really happen, because most people interpreted this message as: people with addictions have deviant brains, and this view provides a reason to stigmatise them in a different way.
In his recent book, Addiction and the biology of desire, Marc Lewis made an impressive attempt to show that behind every addiction is a normal person. His book is a hopeful story, but perhaps too hopeful. He describes a few recovery success stories, but what about the chronic cases? Some have accused him of glorifying and describing addicted persons as heroes. (https://www.washingtonpost.com/opinions/choosing-to-stop-your-addiction/2015/08/20/1097a25e-36f8-11e5-9739-170df8af8eb9_story.html). However, an accusation as strong as this fails to see the authentic stand Lewis takes: he treats addiction as a developmental problem, and this results in a very plausible story of how one can become addicted and how one can recover.
But let’s start at the beginning. Neuroscience is not the robust science most people take it for. Although our understanding of the brain has grown exponentially in the last decade, it is still quite difficult to translate certain brain mechanisms into human behaviour. When following a certain research stream, for example, on the role of the neurotransmitter glutamate, γ-aminobutyric acid (GABA) in addiction, you see different researchers struggling to translate their findings into human behaviour. Researchers with the most catchy metaphors get picked up by the media, but sometimes their metaphors start to live lives of their own. One example is the metaphor that drugs “hijack our brain”. The metaphor is a bit inaccurate, yet, it has become a very popular phrase. Lewis warns about these types of methaphors: ‘So when I say my brain made me do it, or my brain hurts, or my brain really likes alcohol, we are mixing metaphors, confusing levels of analysis. Similarly, to state that craving or pleasure takes place in a certain part of the brain is a figure of speech. (…) Brains don’t have likes or dislikes, rewards or punishments, goals or cravings. Those are things people have.’ Lewis connects the neuroscience back to personal experiences.
Lewis states addiction neuroscience has created a division among addiction researchers. Some think that it holds the holy grail to understanding the mind and addiction, while other think that at the end of the day neuroscience says very little about our personal experiences. There is a tendency to either criticise the mainstream neuroscientific framework, or adopt it. But according to Lewis, there is no need to throw away the brain with the bathwater. He decided to fight fire with fire and reinterpret the neuroscientific foundations of the disease model.
His argument partly resembles that of Foddy and Savulescu http://www.neuroethics.ox.ac.uk/__data/assets/pdf_file/0003/16059/Foddy_and_Savulescu_-_A_Liberal_Account.pdf in their liberal account of addiction: sure, the brain changes in addiction, but brain changes don’t equal disease. What changes the brain, states Lewis, are not the drugs, but the learning mechanisms triggered by substance use. Certain properties of the drugs and the person using them, however, cause accelerated learning. This is mostly what is meant with the hijacking metaphor. But Flanagan convincingly contests the use of ‘hijacking’ as a metaphor by remarking that one can’t hijack one’s own car. Rather, the appeal of substances works through our own genuine desires, or our negative emotions. For the people Lewis describes in his book, substance use fills an existential void in the beginning. One of his interviewees describes how heroin took away ‘the misty layer of anxiety [that] was always floating just above the surface of things’. At first, people control their substance use, so nothing seems wrong. Early on, substance use gives rather than takes. After a while the motivated repetition of the same thoughts and behaviours become habitual. Substance use becomes a nasty, relentless habit. What makes the habit so difficult to change is, according to Lewis, that it is a habit of thinking and feeling – a mental habit – not just a behavioural habit. It’s easier to stop singing in the shower than it is to stop seeing the world as violent or unfair.
And here the developmental psychology comes in to play. Lewis remarks: ‘So when we examine the correlation between addiction and depression (or anxiety), we should recognize that addiction is often a partner of even an extension of a developmental pattern already set in motion, not simply a newcomer who happened to show up one day.’ Substance use starts as an answer to an ache that won’t go away – an ache that usually goes back to early childhood. Substance use becomes a habit very quickly, and habits, in turn, form our personality. When we ask what someone is like, we often characterise them by their habits.
But in the development of the self not only lies the problem, but also the solution. As Lewis nicely puts it: Natalie had to find a self before she could find self-control. When addiction is framed this way as a developmental issue, the concept of recovery gets a different meaning as well. People don’t ‘recover’ from addiction in the sense that the go back to their old selves, rather, they are working through their developmental issues and become a new, richer person. Do you remember those images of your brain on drugs that showed how much damage is done by substance use? Lewis on the contrary refers to a study by Connolly, Bell, Foxe & Garavan
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0059645 that shows that grey matter volume returned to a normal baseline level within six months to a year of abstinence, and continued to grow beyond the baseline level, so beyond the level of people who had never used. The regions of increased growth don’t correspond exactly with the regions initially depleted. This could mean, according to Lewis, that people ‘don’t just regain their lost self-control; they actually develop entirely novel strategies for self-control, based on newly acquired neural terrain.’
So is this false heroism? Is this a romanticising of addiction as Marianne Szegedy-Maszak claims in her review in the Washington post? When I interview people for my research I do not get the impression that all addicted people recover from their addiction enriched. On the contrary, people lose things in addiction that can’t be recovered. However, I find Lewis’ paradigm shift very interesting, and I do think many of the people I interview are on a quest regarding their identity, a developmental quest. And his approach could offer a solution for some people that struggle with addiction. One of the problems I mostly see in people who try to recover is low self-worth because of feelings of shame and guilt, and a low feeling of self-efficacy. A better understanding of the neuroscience of addiction went some way towards releasing people from those unproductive feelings of shame and guilt, but it also entailed a pessimistic message of irreversible damage that was done. Lewis’ book not only shows what happens when people form a strong habit, and why they are so vulnerable to developing a habit, it also shows what happens in the brain during recovery. That doesn’t mean that it is easy to recover, just that it isn’t as hopeless as mainstream neuroscience proclaims. And what’s wrong with giving people hope, especially when they struggle with feelings of low self-efficacy? Why not tell people that it is realistic to demand what seems impossible? Maybe that is the only possible way to recover. I asked one of the persons I interviewed where he saw himself in one year’s time and he replied: ‘probably at the exact same place as I am now’. I thought: that is probably a realistic answer, and on the other hand I thought: if he ever wants to change his life around, he has to at least believe it is possible.