A Review of Biology of Desire: Why Addiction Is Not A Disease – Marc Lewis PHD
This is a review of the book: Biology of Desire: why addiction is not a disease. About the author: He is an evolutionist (see pages 27, 55, 92, 189), a neuroscientist, a professor of developmental psychology, and a previous “addict.” His guide is experience, what he would call science, and logic divorced from biblical truth. He writes from a narrative perspective and then fits the data into his framework. He is passionate and believes his view regrading the brain and of “addiction” is correct. The book is his attempt to prove that point.
The issue of addiction saturates the culture. What it is and how to address it are subjects of never-ending efforts. The Biology of Desire flows from the author’s naturalistic worldview. The physical is key to any behavior. It is important for the Christian to understand what the culture understands. The series: A Review of Biology of Desire is an attempt to do that.
His introduction: A Review of the Biology of Desires
He focuses on the importance of explaining addiction writing “it is more important than ever.” He cites several reasons: public attention, cost, the disease-model rave, and the ubiquity of the activity. He gives his ideas re: addiction by stating he does not believe it is a disease and he explains his reasoning.
Throughout the book he gives definitions for addiction but fundamentally addiction results from the motivated repetition of the same thoughts and behaviors until they become habitual. Later he uses the term desire. He recognizes that man – he thinks of him only as material- has three basic components: thoughts, desires (affections), and actions (will). Actually, this is not bad anthropology but he fails to consider man a duplex being – inner and outer-man, a whole person. His foundational idea is that addiction is learned, more easily learned than most habits, which is due to a narrowing tunnel of attention and attraction. He links desire and attention which results in attraction. He states that the role of desire in the brain is crucial.
His thesis includes: the neural circuitry of desire governs anticipation, focused attention, and behavior. Therefore attractive goals will be pursued repeatedly and other goals lose their attractiveness as the brain’s wiring changes (neuoplasticity) and a neurochemical feedback loop develops. His adage: what wires together fires together. This loop is part of the “normal” brain and its function which is a result of evolution.
He states further that addiction arises from the same feelings that binds lovers to one another and children to parents. He says that “love” is an addiction – it has the same brain pattern on the MRI. He agrees that cognitive mechanisms are at play with the goal to achieve short-term gains more than long-term benefits. He calls this now appeal. (I would call it sensual living as evidenced by Esau (Gen. 25:29-34). He agrees that the brain changes in addiction. Its changes are due to neuoplasticity which is associated with learning and development and are not easy to reverse. The addictive habit (which is redundant in his scheme) gets entrenched through a decrease in self-control – he calls this ego fatigue. These changes come about from “surges of dopamine” and the development of synaptic connections and neurocircuits (neuoplasticity). These circuits were devoted to goal-seeking by the appeal of a single goal.
Based on his experience and logic, he postulates that the brain is our foundation for our needs, our desires, our joy and suffering, our darkest moments and our capacity to overcome them (in essence, man is purely physical and the brain, not the heart, is the center of man. If there is morality, the brain is man’s moral compass – see Time magazine using this title decades ago). Moreover, he writes that the brain is the motivational furnace of all mammals. It is not just the organ of rationality but it is also the biological engine of our striking irrationality (I suppose rationality as well). He postulates a dark side of the brain as the brain shapes our lives and our lives shape the brain.
Chapter 1: Review of the Biology of Desire
He sketches three broad categories given to explain “addiction.” The disease model which states that addiction is a brain disease from a biological perspective. The impetus is on neurochemicals especially dopamine. There is the choice model which emphasizes a cognitive perspective. He quotes figures that say the majority of heroin users from Vietnam stop using. He does not postulate a “why” or a “how.” He mentions the so-called “self-medication” model which he says is a hodgepodge arising from psychology, medicine, and sociology. His review of the disease (medical) model is a nice summary and he gives reasons why it is the front runner to explain addiction. He does say that he is not the first one to clamor against the disease/medical model and gives his rationale.
He calls for a fresh look at the brain. The disease model says the brain is the problem. He says the brain is working normally in addiction. He urges for a proper understanding of how brains work normally. Brain change underlies the transformation in thinking and feeling in early adolescence. He wrote that as many as 30,000 synapses may be lost per second over the entire cortex during pubertal and adolescent period. Further he states as fact that brain changes are necessary for development. Without them there is no learning. Learning changes communication patterns between brain regions and builds synapses. Neurochemicals aid in this development.
He agrees that addiction does change the brain. He inserts a BUT: brain changes occur any way at every level (including gene expression, cell density, synapses number and quality, and shape and size of cortex) with learning and development. Then he says: the kind of brain change in addiction are not different from any other learned behavior, learning, and development. They are the same kind of brain changes that occur in someone absorbed/ obsessed/focused on a person or thing which he calls addiction and later even “love.”
Further he postulates that the brain contains only a few major routes for goal seeking. These routes are apparently the same routes for addiction or loving another (mine: he would include loving or lusting after God and neighbor and spouse) He closes the chapter: brain disease is a useful metaphor for how addiction SEEMS to work BUT not how it does.
Chapter 2: A Review of the Biology of Desire
A Brain Designed for Addiction
We move to chapter 2 in the review of the biology of desire. The brain is a conglomerate of distinct cell assemblies. They do what hundreds of million of years of evolution have determined to be useful: identify things that taste and feel good to us so as to reward (mine: the brain is a reward factory.). Therefore he says: addiction is the uncanny result of the brain doing exactly what it is supposed to do. Brains cells don’t have like or dislikes and they don’t contain thoughts or feelings. They contain molecules, proteins and constantly fluctuating levels of electricity.
He moves to plasticity and permanence in brain change. All brains via evolution are designed for learning and for change. Brains have been changing since birth for function. Over 20 billion cells in the two regions (cerebral cortex and limbic system) are programmable but they are not independent. They are connected by circuits and synapses. The circuits and synapses change and may very rapidly. The change alters the way we experience and interpret things.
He gives a definition of addiction: feeling of desire for something that shapes the brain more acutely than other feelings. It is a desire-laced experience. He says the brain is useless if it is not highly changeable and sensitive. At the same time he says we need stability (? defined) in our precepts, concepts, and actions so habit formation stabilizes. But he says this activity of the brain may be habit forming. Brain changeability which is fundamental to the brain is the rule not the expectation. Therefore, brains changes per say are not the key. The brain is supposed to change with new experiences.
He agrees that addiction is a habit that involves thoughts, desires/feelings and actions (mine: basically an addiction is a way of thinking, wanting, and acting in keeping with normal brain function). Since habits grow, the brain is more a normally functioning brain than a diseased one in addiction. Feedback is key. What drives the experience (mine: he does not say nor does he say why and how the process began) is a pleasant one, a feeling. The brain changes so the sensitivity to fulfilling the desire has heightened and takes less and less to stimulate movement to fulfill the desire but more and more to satisfy it. The feedback loops are in play which promotes neural habits.
Brain cells send and receive electrochemical energy and he repeats: what fires together sticks/wires together so that brains are hardwired. That is how learning takes place but he says it is the affective or emotional experience that starts it. He proposes a scenario: with the first use (mine: he is not interested in this first use and how it got started nor is he interested in motivation) there is a novel firing pattern. Each time and use, the more synapses are formed. The result is the formation of a specific configuration all over brain and its takes less to fire it. With each firing, there is less satisfaction such that the whole brain becomes involved.
He assumes that motivation just is. It is all physical. Basic brain changes occur and form patterns. The basic mechanism of habit formation is change and stabilization of synaptic networks which work differently in different parts of brain. He concludes that in addiction, brain changes are more normal than abnormal.
Chapters 3, 4, 5, 6, 7
In the review of the biology of desire, we move to chapters 3-7. In these chapters, he narrates and interprets the stories of several people according to his thesis. He never addresses the initial activity long before brain changes have occurred. He commented that people stop even though brain changes are already in place. He does not explain this. He speaks of desire ignited. He contends that dopamine is the fuel for desire which intensifies craving and fosters the pleasure circuit. Again and a recurring comment, he does not explain how the desire began in the first place.
He coined the phrase: incentive sensitization. The person trains himself and it is based on the tide of dopamine that flows. People learn addiction through neuoplasticity which is how they learn everything. He believes the brain is a habit-forming machine. Yet he does not explain how the habit began initially. He adds another definition of addiction: compulsive acts of input filling self with something badly wanted and thought needed (mine: he again postulates the connection of thoughts, desires and resultant actions. He pictures this trio only as physical/material – in the body specifically in the brain. Asa nonbeliever, he fails to link the outer man with the inner man making man a whole person). He postulates little or no communication in the areas of brain that control thoughts, desires, actions and assumes a disconnect between the motivational center of the brain (amygdala, Orbitofrontal cortex, and striatum) and the cognitive and affective areas (dorsolateral prefrontal cortex). He gives no reason for this lack.
Chapter 8-9: Biology, Biography, Addiction
He postulates that addiction may be of a substance (drugs) or a behavior (such as porn, gambling, food, etc) and comes from the same brain problem. But he does not answer what begins all of this. He concludes that psychiatry is confused. His point: the brain is working normally as discussed above. He begins with the pursuit of certain objects or behavior – activities. He relates various reasons but the initial step is not part of his definition of addiction. The person pursues certain activities which are attractive. What makes them attractive? What are the people trying to get? He says the reasons are not important because it can be any number of things and the desire and its pursuit just are. He calls them blind desire and recurrent pursuit. He says love fits his definition /description of addiction – at least the brain works the same way. There is an object, a desire, and behavior (pursuit).
In essence he says “lovers” are basically getters. (mine: In his scheme a lover of God is only a getter. The person is obsessed with his love object. The object is not really the other person or thing but self!). The person exaggerates his/her (love object) positive qualities, and the “addict”/”getter”/”lover” avoids thinking of future repercussions. Ego fatigue – he uses this term to describe failing self control – and now appeal – getting it right now – as key terms.
He adds biology: increased levels of dopamine contribute to the focus on the object/beloved and the lover’s tendency to regard the beloved as unique. He gave an example of pair-bonding of mammals and the release of dopamine.
He does say that measurable brain change disappear when a person stops using or the behavior stops. With the proposed tsunami of neurochemicals and developed neurocircuits, how is it possible for them to “turn off: and change? He does not explain these facts.
As he draws to a close he asks: If addiction is not a disease then what is? He reiterates: brain changes as people, their habits, and their personalities develop. A feedback loop strengthens as synaptic pathways are modified – enlarged and increased which results in habituation. Brain changes naturally settle into brain habits of thinking, wanting, and doing. In his scheme, brain changes may explain the continued activity but do not explain its initiation or its ceasing.
He describes addiction as a repeated experience which writes an almost indelible mark on your brain. However, if the experience must continue how does the brain reverse? Why do people change – stop – if brain changes are locked in?
He again defines addiction as a habit that grows and self-perpetuates relatively quickly when we repeatedly pursue the same highly attractive goal (he says the drug is the goal rather than pleasing self). Motivated repetition gives rise to deep learning. Addiction is a condition of recurrent desire for a single goal that gouges deep ruts in the neural underpinnings of the self.
I say whoa: the person is the problem. He wants/expects to get. This is the result of the curse (Genesis 3). For whatever reasons (and there are usually several), the person pursues a feeling with the goal of pleasing self. What the person gets is key. The author says desire is more important than pleasure. The drive to get is what he calls desire. He says the brain is the problem aided by the drug. The Bible says the person is the problem. According to Lewis, “addiction” is selfishness.
He returns to “love affair” and addictions (substances or behavior). Both are ignited by attraction which is rewarded and then there is trouble. The person does not walk away from them unless consequences are intolerable. He claims that addictions satisfy emotional needs (his words!). He claims we all have needs and the right to have them satisfied. This is psychobabble and falls in line with man as a needy person – a need- based philosophy. He unwittingly adds that man has the right to satisfy those needs. The brain has evolved to accomplish this. He postulates that addictions offer an antidote for what the person is feeling.
Therefore, he claims that addiction is need-based and the pursuit of that need is OK because evolution says so. Moreover, he says that addiction is a branch of personality development growing out of the residue of unmet needs and failed attempts. Again, this is fancy psychobabble (for instance, see Adler’s depth psychology focusing in social interests, needs, and goals; and Maslow’s self-actualization theories). The addiction becomes the unmet need that overshadows all the others. At one point he writes that addicts are victims of any number of adverse childhood events. The higher the number meant the person was more likely to be an addict (Mine: in other words, the person is a victim of God’s providence).
In the section on “What brain change means for addicts themselves, ” he postulates that everything is neural: synaptic modifications and dopamine surges all serve up a menu: come and get it/here I am. Basically, the addict is trapped by his own normally working brain – a victim of evolution! Yet he has written that the addict is not powerless! It sounds like Bob Smith and AA! He says it is all dopamine’s fault focusing attention and appeal on only one goal – fulfilling desire.
He did not explain addiction unless he is willing to call the activity he describes as “selfishness” – the pursuit of self and fulfilling needs as a user of others. He writes on page 185 that children learn to look beyond now appeal and stiffen their resistance to ego fatigue. There are brain changes that support improved self-regulation as children grow up. My question: where are those in the addict?
He closes Chapter 9 with the statement: I believe 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. Does that mean the “addict” does it himself? If so how long? How is it possible to change the neural circuits and the flood of dopamine? He does advocate so-called thinking tools to help addiction such as mindfulness and cognitive behavioral therapy. He wrote that not only is this helpful (to produce brain changes) but it is more proof that addiction is not a disease. Then he adds an ethical, philosophical statement: humans need to be able to see their own lives progressing, moving, from a meaningful past to a viable future. He says that empowerment is helpful which takes brains seriously. In his scheme anything that “works the brain” works but thinking God’s thoughts after him has no place!
Conclusion and My Critique: A Review of the Biology of Desire
Lewis has done us somewhat of a favor. He has given some insight into the brain and its workings. I don’t see any reason to doubt his “anatomy.” He has directed attention to thinking, wanting, and action (behavior) which is a step in the right direction. But he has no inner-man concept. He gave information that helps understand motivation as related to the physical and material body and after the process has begun. He does not answer its initiation or its termination. He is woefully incomplete in his anthropology. In writing a review of the biology of desire I was to sharpen my thinking .from a biblical perspective. This will pay dividends in addressing patients with various labels.
Man is a whole person – inner and outer man. He thinks, desire, and acts in both the inner and outer man. Lewis divorces himself from Creator and man as a duplex being. He has no use for the biblical teaching that man is whole person and that the inner man is the motivational center of man.
If the brain changes are real as he describes, they can help explain habituation, at least at the physical level. Brain changes do not help us understand the genesis of “addiction.” Also his discussion flies in the face of Romans 6:6: regeneration removes the enslavement of the whole person to bodily habituation.
In Lewis’ scenario the person is enslaved to his brain and its “normal” functioning. For Lewis the brain serves the pleasures and desire of the person. It is the moral compass and it is self-serving. It serves self at the expense of others. He pictures man as a needy person with all the rights associated with having his needs met. These concepts fit his anti-God, .psychological orientation. He has no place for the Holy Spirit. A review of the biology of desire has helped me refocus myself and others on biblical truth in order to gain victory!
The brain information was interesting but it was more descriptive than explanatory. It may help explain the continuation of a habit but not its origin or termination. Also his view of love is actually getting – using another to fulfill one’s desire. The Bible calls this use of people selfishness, coveting, and idolatry.
Biblical truth is much more robust. Man has origin, identity, purpose, and destiny. These are God-given. After sin and God’s judgment, man became a self-pleaser and functions that way unless a radical change occurs (John 3:3-8; Eph. 5:8-14; Col. 1:13-14). Lewis’ hope is a hope-so-based on personal experience, feelings, and logic divorced from the word of God. He offers no help in explaining man as a whole person involved in self-worship via self pleasing. He does give some information in regards to the body that could help explain habituation – a continued activity. However, people stop behaviors sometimes quickly and sometimes slowly. A person does not need the Holy Spirit to stop a behavior. However, the motivation to please God is in and from the inner man by the Holy Spirit. I urge you to do your own review of the biology of desire. I encourage you to begin with biblical truth and move to the person.
It is interesting to consider whether brain changes occur in the person including Jesus Christ who loved the Lord. According to Lewis, brain changes result in habituation whether good or bad. Is the existential aspect of salvation associated with brain changes which make it “easier” to continue to please God (Ps. 34:8; Phil. 3:8-11)? A real issue that Lewis ignores is the inner man and its habituation. It is not on his radar screen. Biblically, the problem of addiction is the person, not the substance or the behavior. Those latter two are fruit from a heart that is competing with God. Habits are hard to replace. You do not need the Holy Spirit to change habit and the brain. You do need the Holy Spirit to please God.
James T Halla, MD jimhalla@yahoo.com.This material may not be reproduced in any form without the permission of the author.