The arc of Natalie’s descent into addiction began with an experimental appetite for LSD, ecstasy, and, eventually, prescription opiates OxyContin, Percocet, and Dilaudid. From there the college student progressed to smoking, snorting, and finally injecting heroin, a habit that ended in a nine-month prison sentence. Her story is one of five anecdotal case studies described in graphic, soul-baring detail in Marc Lewis’s The Biology of Desire: Why Addiction Is Not a Disease. Like the book’s other principal subjects – a methamphetamine addict, an alcoholic, a prescription drug abuser, and an anorexic – Natalie ultimately reverses her self-destructive decline. The book’s question is, how does she accomplish this? The answer, according to Lewis, is not to be found in the conventional perception that addiction is a disease and, consequently, can be treated as such.

Lewis, a professor of developmental psychology and author of Memoirs of an Addicted Brain: A Neuroscientist Examines His Former Life on Drugs, brings a unique perspective to the subject. He argues that while substance abuse alters brain behaviour – hence its categorization as a disease – its effect on dopamine levels and other measurable brain function isn’t substantially different than what we experience from other surges of pleasure, such as falling head over heels in love. In the case of habitual behaviour, the sense of anticipation is ruled by what Lewis calls “now appeal,” making it increasingly difficult for the addict to adopt a longer, healthier perspective.

It’s significant that all five of his subjects suffered from self-esteem issues growing up, which made them susceptible to compulsive behaviours. At the inevitable risk of oversimplifying a nuanced and complicated argument, growth (Lewis doesn’t like the word
“recovery”) is achieved through the capacity of addicts to escape the “tomb of the present.”

The Biology of Desire is a challenging read, not only for its provocative conclusions but also because of its clinical examination of how the brain works. While interested readers will very likely uncover useful information within its pages, they should not expect the easily digestible platitudes that sometimes buoy the self-help genre.