The Biology of Desire: Why Addiction Is Not a Disease Paperback – August 23, 2016

Well argued and thought provoking. Reframes how one thinks about addiction and behaviour. One thing I would have liked to see would have been a case study on perhaps the most infamous substance - tobacco. I feel like it’s harder to perceive the apparent ‘pleasure/reward’ than it is for other drugs and substances.

This is one of the best books I've read in a long time regarding addiction, though psychology and neuroscience more in general. It should be clear from the outset Dr. Lewis is not anti-psychiatry/medicine/science/etc., does not argue along the lines of Thomas Szasz regarding disease as a metaphor, or in anyway is blind to modern developments in neuroscience, brain scans, or anything along those lines. In fact, he's a neuroscientist and former addict (talk about turning it around).This books underlying thesis is while addiction is a harmful, compulsive, and incredibly hard to control, it is not a disease and should not fall under the disease model. He does not argue in anyway the brain doesn't change from ongoing drug use, as you'll no doubt see in trainings/lectures where people show a heroin brain next to a normal one. Rather, what he argues is the brain changes from just about any experience. So, if you are craving chocolate and have a similar scan your brain will show differences than a brain not craving chocolate. Similarly, if you're in love, which can make us all be a little nuts, your brain will show a very similar scan to someone addicted to heroin. His overall point is strong desires, achieving those desires, strong desires, achieving those desires, eventually results in a feedback loop that disrupts neural/brain processes responsible for modifying our behavior.What was most interesting to me was his discussion of ego depletion in Chapter 8, where he discusses treatment methods or advice from people is actually self defeating. If you are attempting to stop using heroin, alcohol, or what not, simply saying to yourself "I won't use", "I must not use", or something similar is one of the worst things to do because it depletes the very area of your brain that helps you not use heroin, making it more likely you will. Rather, you should reinterpret your experiences, view of the substance, and the situation, which results in less or no depletion.The reason I like this book so much is it's not a pie in the sky, nonsense fluff you will often read and is based on solid research and the way our minds work. He easily combines various brain structures with real life examples to make his underlying point. It is both intellectually demanding (remembering the various brain regions and their interactions) but also very dramatic and real. It's hard not to feel sympathy for some of the people he presents.I'd highly recommend this book. Again, it's not dismissing neuroscience or brain research, he points out multiple times it's important to erase the stigma of addiction so people can get help, but he shows in a very concise, understanding way we should not view addiction as a disease similar to cancer, diabetes, or what not. It's very readable and combines current research with good stories of people he's spoken to who have been through heroin, meth, and alcohol addiction up to someone being anoxeric and how they're similar.

I purchased this book out of curiosity about the subject, and not because I have a personal stake in it or am a student. This book was off to a slow start - the first few chapters are fairly repetitive, and the information is presented in a dense way that a lay-person might find forbidding. To a student this may be very appropriate, however, as the author does explain how he came to make his claims in a detailed manner. The chapters containing the case studies were amazingly interesting to me. I am only giving this book a four star review because I don't think the science behind the content is presented in a simple and objective way. I would recommend this book to people who are either dealing with recovery, or want to understand how a drug addict's brain works, or even how brains work in general.

I have read Lewis' other book and follow his blog, and find his arguments among the most clear and comprehensive out there. He is not to be dismissed based on the title alone, which other reviewers seem wont to do. I'm giving this book 5 stars because it taught me things I did not know, despite having read hundreds if not thousands of peer-reviewed articles on drug use and addiction. Anything that makes me think differently about my own field of research deserves 5 stars.Lewis manages to synthesize a large body of literature that a layperson (which I am when it comes to the neurobiology of addiction) cannot do on one's own. I've always wished I could have a conversation with an addiction neuroscientist who had not blindly accepted the disease model, and that is essentially what this book is. However, his disagreements with others such as Nora Volkow are actually quite subtle and sophisticated, and I wonder if readers will miss the subtlety, chalking it up to mere semantics. For instance, “hijacking” of the brain’s natural reward system is the metaphor often used in the brain disease model, which some might argue is not that different from Lewis’ notion that addiction is an “accelerated” or “deep” form of the developmental learning our brains are meant to do. However, I think one crucial difference is he’s challenging the notion that the DRUG is the key point on which to intervene. The disease model needs a vector or pathogen, which the drug becomes, and this turns our attention away from what the person is experiencing and the meaning attached to that experience. Rather, Lewis argues, we have a natural motivation toward powerful emotional experiences, and drugs can provide a particularly powerful experience that we more quickly learn to seek out than other, less powerfully motivating experiences (nonlinear dynamics here being critical). Over time, people who are addicted (and not just to drugs) become trapped in the moment-to-moment experiences and disconnected from their past and future. The question becomes, how does the perspective change such that the meaning attached to the experience drugs provide is less powerful? (Understanding this also can help us to understand why most people who try drugs, even heroin, do NOT become addicted...for whatever reason the experience was not as powerful or as meaningful for them.)When we turn our attention away from the big, bad drug, it really does change how we intervene. In particular, we have a lot more to learn in exploring Lewis’ theories around ego fatigue, the addict’s perspective on time (linear v circular), and "social scaffolding." What might drain some people’s willpower more than other people’s? What are the effects of stress, inequality, oppression, and poverty on one’s ability to avoid ego fatigue, or on one’s ability to envision a better future? More importantly, what causes one to shift perspective, and can social scaffolding precipitate and not just take advantage of these shifts in perspective?

As a psychotherapist, I have always known that most ‘diseases of mental illness’ are mythological; most behaviors and beliefs I treat with education and overcoming fear. Yet, I never really thought this about addiction. Why not? The ASAM lobbying is based on exceptional marketing. Dr. Lewis’ book makes it clear that addiction is not a disease and should be treated with psycho-education and accountability. Until accountability is pushed, addiction and excusing addiction will continue to only get worse. And, many people are and will (or will continue to) get hurt because of this.