The Heart and Mind of Addiction

In the darkest days of my alcoholism, it became very important to me to think of my disordered life as the consequence of a brain disease. I spent a lot of time gathering evidence that my cravings and lack of discipline were somehow rooted in my faulty neurons, just as a diabetic's symptoms derive from a faulty pancreas. I found strange comfort in this idea, and even more in the possibility that I had inherited my alcoholic father's unfortunate genes.

I know now why this line of thought was so appealing. It absolved me of responsibility for my wreckage, and at the same time raised hope for a medical cure. I hoped and believed that a pill would soon become available to stem my cravings and end my torment.

This naïve thinking was itself a product of my immoderate drinking. It certainly exemplifies the thinking that Sally Satel and Scott Lilienfeld deconstruct in their important new book, Brainwashed: The Seductive Appeal of Mindless Neuroscience (Basic Books). Satel, a psychiatrist and scholar at the American Enterprise Institute, and Lilienfeld, a psychological scientist at Emory University, are critical of the "neurocentrism" that has infiltrated American intellectual life, from the law to economics and finance to philosophy. Their mission is to correct such distorted thinking before it does more harm than it has already.

The authors devote an entire chapter to addiction, beginning with this anecdote: During the Vietnam war, high-grade opium and heroin flooded Southeast Asia, and many American soldiers got hooked. By 1971, the situation had become so bad that the New York Times labeled it an epidemic, leading President Nixon to issue an order: No soldier would be allowed to return home without passing a urine test. This effort, called Operation Golden Flow, succeeded beyond expectations. Almost all of the addicts were able to clean up and pass the test, and only a tiny minority relapsed back at home. Operation Golden Flow put the lie to the accepted wisdom: "Once an addict, always an addict."

This lesson was short-lived, however, and today it is the official view of the National Institute on Drug Abuse that addiction is a "chronic and relapsing brain disease." What's more, this disease model today has the gloss of neuroscience to legitimize it, complete with colorful fMRI images of addicted brains. This dogma dispenses with questions about will and morality and reduces all addictions to "hijacked" brain circuits involved in reward and pleasure.

Satel and Lilienfeld effectively debunk this reductionist view. They show that many addicts continue to have large periods of calm in their daily lives, during which they make the usual decisions about jobs and children's schools and so forth. What's more, most quit. Indeed, quitting is the rule rather than the exception. This would not be true if were an unrelenting and permanent brain affliction.

Government drug czars have routinely embraced the brain disease model of addiction, in part because it is easier to argue for more funding using colorful brain scans. But this strategy leaves the harmful impression that the brain is the only important level of analysis and understanding of addiction. It sidesteps the crucial issue of psychological motivation. Many addicts, including alcoholics, make a choice to quit because they are embarrassed, worried about kids and family and job security, spending too much money, on and on. Recovery, the authors correctly note, is in the end "a project of the heart and mind." The search for a magic bullet -- the one I yearned for in the throes of my addiction -- is pure folly, Satel and Lilienfeld conclude.

Brainwashed -- which also includes chapters on "neuromarketing" and "neurolaw" -- is not an anti-neuroscience book by any means. Indeed, the authors celebrate the new insights into human thought and behavior that brain studies have yielded. But the book does take a hard stand against the prevailing neurocentrism, and aims to restore some balance to our understanding of human fallibility, including drug and alcohol addiction.

Wray Herbert's blog--"We're Only Human"--appears regularly in The Huffington Post.