The key ideas

The Biology of Desire: Why Addiction Is Not a Disease

Marc Lewis, 2015

Why is addiction so hard to give up, even when people can see for themselves that it is ruining them? Neuroscientist Marc Lewis, who was addicted to opiates as a young man, takes on the familiar idea that addiction is a chronic brain disease. In his view, addiction is learning, very deep and very fast, and what drives it is intense desire. Through five real stories, you will see what happens in the brain along the way and understand why, for Lewis, people do not recover from addiction so much as grow out of it.

Who it is for

For anyone who wants to understand why people keep going back to the very thing that is destroying them. And for anyone who has watched addiction up close, or noticed a habit taking over, and wants to make sense of it without labels.

The same brain changes seen in addiction also show up when people get passionate about sports, join a political movement, or fall head over heels for a lover or their own children.

A scientist who had been on the other side

Toronto, the mid-seventies. A young man arrives to study psychology and brings with him an addiction to opiates that began back in his student days at Berkeley. Ahead lie theft, needles and trouble with the law. He is pulled ever harder toward the thing he hates more and more. At thirty he quits, and later he becomes a professor of developmental psychology and a neuroscientist.

His name is Marc Lewis. In 2015 he published a book with a provocative subtitle: "Why Addiction Is Not a Disease". In it he argues against a position held by many doctors and by America's main institute for drug research: that addiction is a chronic brain disease that recedes and then comes back.

Lewis sees it differently. Addiction, in his view, is learning. The brain is doing what it was built to do: seeking out whatever brings relief and pleasure, and wearing a path to it. With addiction, though, that learning runs especially deep and fast, because intense desire is driving it.

Lewis does not make his case with brain scans alone. He tells five real stories: Natalie, Brian, Donna, Johnny and Alice. Each of them went a long way into addiction, and each found a way out. You will see what happens in the brain at every step of that road, and why, for Lewis, leaving addiction behind looks less like recovery and more like growing up.

A disease spotted on brain scans

The United States officially declared the nineties the Decade of the Brain. New machines could show which parts of the brain were active at any given moment, and scientists began comparing the brains of people with and without addiction. They found differences: the reward system worked differently, and there was less gray matter in the areas responsible for self-control.

A strong conclusion grew out of those scans. The National Institute on Drug Abuse, NIDA, declared addiction a chronic, relapsing brain disease. Its director, Nora Volkow, believes this view helps fight stigma: it is harder to condemn someone who is ill.

Lewis does not dispute the scans themselves. The brain really does change with addiction, he agrees. The argument is about something else: how to read those changes. If the brain has become different, does that mean it is diseased? Lewis says no, because the brain changes with any powerful experience.

Even more important to him is the cost of the label. A chronic disease is, by definition, incurable: you can keep it under control, but it never goes away. A person who has come to believe they are ill for life may stop believing they can change anything on their own.

Read in Livria

About the author

Marc Lewis is a Canadian neuroscientist and developmental psychologist. For many years he taught at the University of Toronto and at Radboud University in the Netherlands. As a young man he was addicted to opiates and quit at thirty, then went on to write two books on the science of addiction.

All books by this author: Marc Lewis

Terms from the book

  • Dopamine
  • Alcoholics Anonymous
  • Prefrontal cortex
  • Psychedelics
  • ecstasy
  • Neuroplasticity
  • Volkow
  • Attention deficit disorder
  • discounting
  • Howard
  • Striatum
  • Synapse
  • Deep learning
  • Berridge
  • Orbitofrontal cortex
  • Compulsion
  • Tai chi
  • NIDA: The National Institute on Drug Abuse, a US government agency that funds a large share of the world's addiction research.
  • Pruning: The trimming of connections in the brain: synapses that are hardly used die away. The process is most active in childhood and adolescence.
  • Opiates: Substances from the opium poppy and their derivatives. They dull pain and bring a feeling of calm and wellbeing, and addiction to them develops quickly.
  • Opioids: Here: the brain's own chemicals that act much like opiates. They are linked to pleasure and pain relief.
  • Ventral striatum: The lower part of the striatum, a region deep in the brain. It is where dopamine has its strongest effect on desire and motivation.
  • Methamphetamine: A powerful synthetic stimulant. It brings a rush of energy and focus, and addiction to it develops quickly.
  • Medial prefrontal cortex: The inner part of the prefrontal cortex. It is involved in how we think about ourselves and about other people.
  • Bulimia: An eating disorder: bouts of binge eating followed by attempts to get rid of what was eaten.
  • Anorexia: An eating disorder in which a person severely restricts food and fears gaining weight even when dangerously thin.
  • Ego fatigue: Here: the phrase Lewis uses for the exhaustion of a long struggle against desire. The lab idea that willpower runs down like a resource is itself disputed in psychology.
  • ACE: Short for Adverse Childhood Experiences. The name of a study that added up the hard events of a person's childhood into a single score.
  • Pickard: Hanna Pickard, a philosopher who studies addiction, responsibility and mental disorders.
  • Wakefield: Jerome Wakefield, an American researcher known for defining mental disorder as "harmful dysfunction".

All terms

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