Pubdate: Sat, 22 Aug 2015 Source: Age, The (Australia) Copyright: 2015 The Age Company Ltd Contact: http://www.theage.com.au/ Details: http://www.mapinc.org/media/5 Author: Jenny Valentish Drugs Marc Lewis Argues That Addiction Is the Result of ' Deep Learning', Probably Triggered by Stress or Alienation. It Can Duly Be Unlearned... Via Better Habits THE GRIM CIRCLE OF ADDICTION For a long time, Marc Lewis felt a body blow of shame whenever he remembered that night. " We thought you were dead," accused one of his mates, leaning over him. Lewis was slumped half-naked in a bathtub. " We were just talking about what to do with the body." Lewis was at only the beginning of his odyssey into opiates. After this overdose, he dropped out of university and didn't pick up his studies for another nine years. At the next attempt, he was excelling at clinical psychology when he made front page news. He'd been busted raiding a pharmacy for goodies, hopefully Demerol or Methedrine. That was careless; he'd been successfully pulling off three or four break- ins a week. That was 34 years ago. Now 64, Professor Marc Lewis is a developmental neuroscientist, based at the Radboud University in Nijmegen in the Netherlands. He details his early exploits in 2011' s Memoirs of an Addicted Brain. His new book, The Biology of Desire: Why Addiction Is Not a Disease, cements his image as a rock star of neuroscience by loudly challenging the status quo. The prevalent theory in the United States, and to some degree in Australia, is that addiction is a chronic brain disease - a progressive, incurable condition kept at bay only by fearful abstinence. There are variations of this disease model, one of which became the basis of 12- step recovery and the touchstone of most rehab programs. Lewis argues that addiction - or dependence, as we would call it in Australia - is the result of "deep learning", probably triggered by stress or alienation. It can duly be unlearned by forging stronger synaptic pathways via better habits. The implication for the $ 35 billion treatment industry in the US is that tackling addiction as a medical issue should be only a small element of a more holistic approach. The problem is, there's a lot of vested interest - and financial investment - in perpetuating the disease model. There's consensus on the science, at least. As Lewis explains to The Saturday Age, repeated alcohol and drug use causes tangible changes in the brain. " We all agree on that," he says. " The changes are in the actual circuitry, within the synapses that connect the striatum to other parts. " The longer a time that you spend in your addictive state, the more the cues attached to your drug or drink of choice is going to turn on the dopamine system," Lewis says. At the same time as the release of dopamine, nicknamed the feel-good chemical, is being ramped up, there is decreased activity in areas of the brain responsible for judgment and decision-making. According to the globally influential US- based National Institute of Drug Abuse ( NIDA), these neurobiological changes are evidence of brain disease. Lewis disagrees. Such changes, he argues, are induced by any goal-orientated activity that becomes all-consuming, such as gambling, sex addiction, internet gaming, learning a new language or instrument, and by powerfully valenced activities such as falling in love or religious conversion. And while the American Medical Association may have classified alcoholism as a disease in 1956 and obesity in 2013, it hasn't gone so far as to similarly smote love or Catholicism. While the disease concept suggests that a person who has become abstinent will be in perilous remission forever, Lewis argues that new habits can overwrite old. " People have to really be ready, because there has to be a powerful surge towards other goals," says Lewis. " Goals about their relationships and feeling whole, connected and under control. The striatum is highly activated and looking for those other goals to connect with." Lewis certainly isn't the first scientist to believe that " most people who become addicted are experiencing some kind of loneliness, depression or alienation". He cites psychologist Stanton Peele - who has tablet-humped the idea since the 1970s that addiction is a learned behaviour influenced by personal suffering - and neuropsychopharmacologist Carl Hart. What's undeniable is that the disease concept they reject is deeply embedded into our culture, largely through Alcoholics Anonymous. Lewis doesn't entirely discredit AA - which in Australia has close to 20,000 members - but he does suggest that while 12- step recovery "works for some addicts, it does so by promoting a kind of PTSD". As for rehab, he concedes that medicine needs to be there as an adjunct for those transitioning through withdrawal and maintenance periods, " but you don't need to go to a rehab centre that costs $ 50,000 a month because it's got medical care that turns out to be bullshit, diluted by 12- step meetings, group meetings and equine therapy. " It's really a fraud," he says, " when there are better ways, such as outpatient rehab." Professor Steve Allsop, from Curtin University, is concerned that the disease model over-simplifies drug and alcohol problems with one- sizefits- all assessment and treatment. As director of the National Drug Research Institute ( NDRI), based in Perth, he's instrumental in the policies of the more multifaceted public health model in Australia. This model advocates harm-reduction, with abstinence at one end of the spectrum. " I'm not suggesting anything goes," he says. " But some people find in-patient care critical, or long-term help in a collegiate community such as AA, or are helped by particular pharmacotherapies. No single approach has been demonstrated to be ' the way'." In the US, a person needs to have a definable illness to have treatment covered by health insurance, so to have NIDA classify addiction as a chronic brain disease facilitates that process. Professor Suzanne Fraser is the leader of Australia's NDRI's Social Studies of Addiction Concepts Research Program and one of the authors of the book Habits: Remaking Addiction. She says, " The neuroscientific disease approach is heavily promoted by NIDA under the leadership of its director, Nora Volkow, who believes that calling addiction a disease will reduce stigma. " It seems Volkow's approach to addiction is in part informed by her own experiences of family drug consumption in The Huffington Post she's called her grandfather's alcohol problem a ' disease of free will'. Like other researchers, her view is shaped by her personal experiences, yet NIDA's research is presented as though it has achieved a bias-free viewpoint, from which it can tell us the truth of drugs and addiction." Professor Alison Ritter, director of the Drug Policy Modelling Program at the University of NSW says when NIDA first adopted the disease model it was to de-stigmatise addiction and, as a medical condition, to make it eligible for government funding. During the 1990s known as the " decade of the brain" - advancements in neuroscience and brain imaging meant " technology caught up with the terminology", Ritter says. " There seemed to be a shift from the term ' disease' as a rhetorical device to something that Americans believed literally. This simplifies dependence down to brain chemistry. In reality, it is a complex cultural, social, psychological and biological phenomenon." Ritter predicts fatigue with the brain disease model. " It has not produced any new technologies for treatment nor necessarily decreased stigma or improved the lot of people who experience dependence problems. So in a sense, there is this available space to ask: ' What has it been good for, if anything?' " For now, Lewis is looking forward to hearing about the " progressive-sounding" system in Australia when he speaks at the Melbourne Writers Festival next week and then at the Festival of Dangerous Ideas at the Sydney Opera House in conversation with Johann Hari, author of Chasing the Scream: The First and Last Days of the War on Drugs. " I agree with his [ Hari's] emphasis on the importance of connection," says Lewis. " He says ' the war on drugs' is exactly the wrong term and I agree with that, too." Not all of Lewis' meetings are likely to be so harmonious - he's particularly holding out for a pas de deux with the NIDA's Nora Volkow. " I'm sure there are people out there who think I'm a fraud," Lewis laughs, when asked if some researchers might grumble that he is biased by his own success story of giving up drugs his way. " For this new book there were three customer reviews on Amazon before it had even come out, giving it one star. These people proclaimed that I must be an asshole: ' If Lewis is a scientist then I'm an astrophysicist.' They probably think I'm making excuses for myself. But I think my credentials are pretty good." Lewis himself knows that the success of his book is a double-edged sword. " I did this talk show in New York and one of the callers was pleading with me, ' Don't take this away from us. I need this in order to get on with my recovery.' That's pretty heartbreaking for me. I don't want to take away from somebody something that's going to make them feel better. I just think in the big picture the disease model is doing more harm than good." Professor Marc Lewis appears at Melbourne Writers Festival, Deakin Edge, August 30. - --- MAP posted-by: Jay Bergstrom