The main idea of this book is to use author knowledge as neuroscientist and experience as recovered addict to promote non-traditional view of addiction as strong habit established via process of deep learning accelerated by overwhelming desire to escape some difficult life problem in quick and easy way. Correspondingly author suggest that the way out of addiction lay not in medication or group therapy, but rather:” addiction can only be beaten by the alignment of desire with personally derived, future-oriented goals.”
Here author presents challenge to the idea that addiction is a disease:” This book makes the case that it isn’t. Addiction results, rather, from the motivated repetition of the same thoughts and behaviors until they become habitual. Thus, addiction develops—it’s learned—but it’s learned more deeply and often more quickly than most other habits, due to a narrowing tunnel of attention and attraction.” He then describes the structure of the book as combination of scientific presentation and story of ordinary people who were addicted and then were able to overcome addition. Author also presents himself as neuroscientist, professor, and former drug addict who had experienced both addiction and recovery.
Chapter One: Defining Addiction: A Battleground of Opinions
In this chapter author reviews history of different definitions of addiction and correspondingly different approaches. He presents 3 models of addiction: mental disease, lifestyle choice, and self-medication to fight depression and/or any other problems. He points out that that:” These three models of addiction overlap to some degree, but each has unique implications for research, funding, and care, from the level of government policy to that of treatment options for individual sufferers. To put it simply, the disease model calls for treatment at the hands of experts—generally medical experts (including psychiatrists) but also the burgeoning band of treatment personnel who report to them (at least in theory); the choice model advocates reviewing one’s beliefs and changing one’s perspective, often using standard psychotherapeutic techniques such as cognitive behavioral therapy and motivational interviewing; and the self-medication model stresses the need to protect children and adolescents from extreme psychosocial pressures and to diagnose and treat underlying developmental issues that may have predisposed a person to addiction.” After that author expresses dissatisfaction with these models and intention to present more viable comprehensive model. But before this presentation he allocates some space reviewing history of disease model and debating its validity, which based on discovery of biological changes in brains of addict. Author’s main argument against this is that brain is very plastic and changes all the time as result of political attitudes, falling in and out of love and similar conditions. He concludes:” Brain disease may be a useful metaphor for how addiction seems, but it’s not a sensible explanation for how addiction works.”
Chapter Two: A Brain Designed for Addiction
Here author discusses characteristics of a brain, its plasticity, process of learning, and accommodation to reality. Author them moves to habit forming and how it linked to addiction:” The brain is certainly built to make any action, repeated enough times, into a compulsion. But the emotional heart of addiction—in a word, desire—makes compulsion inevitable, because unslaked desire is the springboard to repetition, and repetition is the key to compulsion. Like all habits, addiction quite simply grows and stabilizes, in brain tissue that is designed (by evolution) to change and stabilize. Yet addiction belongs to a subset of habits: those that are most difficult to extinguish. To understand addiction, we need to see it as the outcome of a normally functioning brain, not a diseased brain.”
Author then discusses how brain is changing under impact of multitude of different feedback loops and how addiction and other nasty things could be developed:” Bad habits self-organize like any other habits. Bad habits like addiction grow more deeply and often more quickly than other bad habits, because they result from feedback fueled by intense desire, and because they crowd out the availability or appeal of alternative pursuits. But they are still, fundamentally, habits—habits of thinking, feeling, and acting. The brain continues to shape itself with each repeat of the addictive experience, until the addictive habit converges with other habits lodged within one’s personality”.
At the end of this chapter author presents the key point of his views about negative changes in the brain related to addiction:” These changes don’t result from addictive substances. They are not caused by booze or drugs. They result from having a string of similar experiences. Nice experiences. Experiences of relief. Experiences that feel good, or at least better than the rest of your boring and depressing life. These brain changes are caused by motivated repetition—repetition of something special—and how the brain responds to it. The powerful experiences that get the ball rolling are simply events that affect us deeply. Because they are engaging. Because they mean something. As they become even more meaningful, the corresponding brain changes gather more momentum, building on themselves, digging their own ruts—rainwater in the garden.”
Chapter Three: When Craving Comes to Power: Natalie’s Story
Chapter Four: The Tunnel of Attention: Brian’s Romance with Meth
Chapter Five: Donna’s Secret Identity
Chapter Six: Johnny Needs a Drink
Chapter Seven: Nothing for Alice: The Double-Edged Sword of Self-Control
In these 5 chapter author reviews stories of people, which demonstrate variety of form of addiction and how these people were able overcome it by treating addiction more as bad psychological habit that should be grown out of, than bodily disease, that should be treated with medication or surgery.
Chapter Eight: Biology, Biography, and Addiction
In this chapter author goes into detailed reasoning on why addiction is not a disease and provides summary of this reasoning:
Here is authors conclusion:” So, what exactly is addiction? It’s a habit that grows and self-perpetuates relatively quickly, when we repeatedly pursue the same highly attractive goal. Or, in a phrase, motivated repetition that gives rise to deep learning. Addictive patterns grow more quickly and become more deeply entrenched than other, less compelling habits because of the intensity of the attraction that motivates us to repeat them, especially when they leave us gasping for more and other goals have lost their appeal. The neurobiological mechanics of this process involve multiple brain regions, interlaced to form a web that holds the addiction in place. Often, emotional turmoil during childhood or adolescence initiates the search for addictive rewards, which can provide relief and comfort for a while. But there are other points of entry too. Addiction is a house with many doors. However it is approached, and however it is eventually left, addiction is a condition of recurrent desire for a single goal that gouges deep ruts in the neural underpinnings of the self.”
Chapter Nine: Developing Beyond Addiction
The last chapter is about getting out of addiction and here is author’s reasoning:” I believe that getting past one’s addiction is a developmental process—in fact, a continuation of the developmental process that brought about the addiction in the first place. And the biology of neural change—the way brains transform themselves and the way habits form and reform—helps explain how that developmental process works. In fact, the importance of ongoing brain change becomes difficult to dispute when we link the neurobiology of addiction with the stories of those who have been there and moved on. That’s the insight that inspired the structure of this book.”
He then discusses biology of this process: neuroplasticity, experiential and neural paths to quitting, and how realign one’s desires to get out of the addiction.
MY TAKE ON IT:
The area of human life discussed in this book – addiction is completely unfamiliar to me, except that on two occasions I had alcoholics working for me. Both times they were very nice people who were competent professionals unless they get drunk and then become incompetent even to keep their bodies upright. In both cases it was tragic and sad. Both had been in treatment many times and both returned to addiction after a few months or even years of being sober. This book is interesting by moving the topic away from medical / chemical approach to fighting this condition to psychological / lifestyle adjustment method that worked for author and seems to be working for other people. It would be interesting to know if this new approach really works, but I would bet that even if it is working, the implementation would be difficult if not impossible because way too many interests and the whole industries depend on people struggling with addiction forever without winning and people who are running these industries would not give up without serious fight.