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Uncommon Pathways to Recovery

Despite a common neural pathway to addiction, people recover in diverse ways.

It's not that simple

My book is being released in the US this week, and I've been getting more and more interviews and reviews from US media. On February 18th, a New York Post article featured the book prominently, but I was taken aback when I read it. Most newspaper and magazine coverage of the book has been pretty good, despite various factual errors. But this article had some of my words and convictions turned completely upside down. For example:

"Along with many other leaders in the field, Lewis believes that the recovery model needs an overhaul, that addiction should be treated as a manageable disease, akin to HIV, rather than a curable one."

I don't think of addiction as a disease at all. Sure, the disease metaphor resonates with aspects of addiction. But whenever I'm asked (as I was this time), I describe addiction as a form of learning. It's a kind of learning that's vastly accelerated and self-reinforcing. But it's not a disease. And I would never, in my wildest dreams, compare addiction to HIV -- there is NO VIRUS at work here.

I don't blame this columnist for trying to fit addiction into a familiar mould. The gist of her article was about inadequacies in the 12-step approach, and we were in synch on many points. In fact, her aim was to find a simple answer to a complex question. What is addiction and how do we "cure" it?

But I don't have a simple answer.

My book and my other writings highlight the commonalities among addictions and among addicts. I emphasize a "common pathway" of addiction in the neurochemistry of dopamine, the role of the ventral striatum in craving, and the sculpting of synaptic networks (in the orbitofrontal cortex) that imbue drug, drink, or whatever it is with value. Other neuroscientists also believe in a common pathway for all addictions. Along with ego fatigue, and a few other well-documented findings, these neuropsychological realities reveal something universal about addiction. So a lot of my message is that we share the same brain -- with its characteristic frailties -- and when we fall, we fall down the same rabbit hole, and share the same challenges when we try to climb out.

And yet...what I have learned, not only from the addiction literature but from ex- and recovering addicts writing in to my home blog, is that people recover in vastly different ways.

First come the statistics. About 5% of alcoholics stop for good on their own every year (see this opinionated but fascinating review). That's about 40% (from a group defined in year 1) over 10 years. The rate of spontaneous recovery appears to be far higher for narcotics addicts (see the recent book by Gene Heyman). Second, harm reduction really works: many people don't stop using but they slow down or clean up enough to stop destroying themselves -- another natural process of healing. Third, comments and emails from ex-addicts clearly demonstrate that, as difficult as it is to ignore craving, many of us manage to resist it or outsmart it until it becomes manageable, on our own, or with friends, or with family, or with our partners, or in the care of recovery programs (12-step based or not), or in therapeutic communities, or with private therapists, or, or, or...

I'm continuously blown away by how much diversity there is in how people get by and get out.

So what do I tell journalists who want to know the answer ? Yes, brain characteristics are fundamentally relevant to the addiction process. Yes, finding a "common pathway" in the neuroscience of addiction is critical, both for addicts and for those involved in helping them. But no, there is no common pathway to recovery. Some of us take comfort in following rules. Others abhor them. Some of us need to feel cared for before we can stop. Others need to feel more independent. And there are all those shades of grey, those mixtures and variants, among them. We are each individuals, with unique experiences, capacities, affinities, and aversions, and our creativity is probably the most important element in our recovery.

That doesn't sound at all like a disease.

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