Globe and Mail Article
From Saturday’s Globe and Mail. Read it on The Globe’s site
Published Friday, Sep. 30, 2011 6:43PM EDT
The indelicate problem was this: Marc Lewis, the budding psychologist, would break into a building to steal drugs, especially Demerol, to junk into his arm, and then the urge would hit him.
“Whenever I broke into a medical centre I would have to go and poo,” he says over the telephone from the Netherlands. Needless to say, a bandit who has to visit the can every time he commits a break-in is asking for trouble.
Dr. Lewis found it. After 15 years of drug addiction – cough syrup and pot at high school, heroin and acid at Berkeley in the late 1960s, opium in India and all that plus methamphetamine as a 30-year-old graduate student in Windsor and Thunder Bay – he was finally caught in the act and sentenced to months of probation.
It was only then – ashamed, ditched by his girlfriend and finally crushed by a life of substance abuse – that he set off to try to understand the workings of the mind and, eventually, what lies at the heart of addiction.
The result of that long, strange journey is his new book, Memoirs of an Addicted Brain: A Neuroscientist Examines his Former Life on Drugs.
Out next week, it is set to make a counterintuitive splash in the vast sea of brain books that includes the bestselling The Brain That Changes Itself(Canada’s Norman Doidge) and Just One Thing: Developing a Buddha Brain One Simple Practice at a Time (the latest by neuropsychologist Rick Hanson).
Memoirs of an Addicted Brain, however, takes on all of human longing. Unlike many of his brain science colleagues and fellow addicts, Dr. Lewis can write.
One moment, he is remembering the details of his life as an addict; the next, he is reconstructing, based on newer scientific findings, what the drugs were doing to his brain.
The result is not just a book about a brain on drugs, but a picture of addiction as an unavoidable urge of human nature.
The human brain turns out to be a sucker for pleasure, driven by the desire to feel relief from the watchfulness of being human. With the naturally occurring anxieties of life – loneliness, randomness, death – further compounded by the non-stop technologies of the godless 20th century, it is a wonder that only 10 to 20 per cent of us (Dr. Lewis’s estimate) are functionally addicted to something or other.
This is your brain on dopamine
Using neurophysiology to understand addiction is a particularly effective storytelling device because drugs engage every part of the brain. Meaning (in the limbic system), physical sensations (in the brain stem), memory (from the hippocampus and elsewhere), emotions (the amygdala), ideas and decision-making (the cortex) are driven by a quiver of neurotransmitters – the main culprits (for Dr. Lewis’s purposes) being dopamine, which makes us long to feel good, and opioids, which actually make us feel good (and produce more dopamine, just to keep the cycle going).
“It is dopamine’s flame of desire,” Dr. Lewis writes, “unleashed by the ahhh of opioids, that causes animals to repeat behaviours that lead to satisfaction. Here in one neat package is the chemistry of learning. … Yet there’s a downside: the slippery slope, the repetition compulsion, that constitutes addiction. In other words, addiction may be a form of learning gone bad.”
Heroin, pot, opium, laughing gas, ketamine and other members of the good doctor’s extensive phantasmagoria supply usually hard-earned satisfactions instantaneously – whereupon the ever-plastic, quickly-learning brain turns the short cuts into the only route open to the top of the mountain. Addiction is how the brain corrupts itself. As Dr. Lewis notes in the opening sentence of his book: “We are prone to a cycle of craving what we don’t have, finding it, using it up or losing it, then craving it all the more. This cycle is the root of all addictions – addictions to drugs, sex, love, cigarettes, soap operas, wealth and wisdom itself.”
His descriptions of how various drugs produce their effects will ring many bells on their own. But it’s the way he drapes his scientific understanding of human chemical function over the frame of his own life that makes his memoir compelling.
What causes addiction? That’s always a big question. Dr. Lewis traces his own to anti-Semitism at exclusive Tabor Academy, a Massachusetts boarding school where he was sent against his wishes by his parents. They were ambitious Russian Canadians in Willowdale, Ont.: his father arrived in Canada and retrained as a doctor. (He later diagnosed one of his son’s three bouts of hepatitis, and prescribed complete rest and no recreational drugs. “So what I did was take two gigantic capsules of organic mescaline and climb to the top of the Berkeley Hills.”)
“I think my parents were idiots in a way,” Dr. Lewis says. “They weren’t evil, they just made a big mistake of letting me go to that school. My mother was dissatisfied in the marriage, and I think in some ways she wanted to kind of push me along some path that would be exciting and special and unique.”
He’s hardly alone in blaming his parents. Thomas de Quincey, whoseConfessions of an English Opium-Eater was published in 1821 (Dr. Lewis claims not to have read it), was left in the care of four guardians when he was 7 after his father died. His mother, meanwhile, was reported to be “deficient in the fine sympathy.”
It turns out that parental neglect is a factor worth considering. The latest neuroscience suggests the brains of children and adolescents are particularly susceptible to deep patterning.
Dr. Lewis’s point, however, is not blame, but that human susceptibility to addiction feeds on a hunger for inclusion. Mother’s milk, after all, contains opioids, which produce feelings of warmth and safety in the brain and counteract impulses from the amygdala that create anxiety and loneliness. Opioids evolved over the course of 150 million years, probably as means of pain relief. “Perhaps a sense of relief is the main ingredient in the mammalian formula for feeling good,” Dr. Lewis posits. The late Hunter S. Thompson – no stranger to addiction – quoted an unnamed poet to much the same effect in the epigraph to his own faceoff with freak-outs, Fear and Loathing in Las Vegas: “All my life my heart has sought a thing I cannot name.” That is the motto of the drug adventurer. They don’t call heroin “mother” for nothing.
In the ongoing battle between the disease model of addiction (addicts are born, not made) and the hard-line choice model (addiction is a decision), Dr. Lewis the neuroscientist is firmly in between. “It’s a false dichotomy,” he insists. “The choice people say, hey, … we don’t need to understand the physiology of this stuff, because everybody’s brain is the same, and some people become addicts and some don’t. And that’s bullshit. It is about the brain – about hijacking certain brain mechanisms and a really powerful synaptic network that keeps reinforcing itself.”
On the other hand, he says, “addiction is not a disease like hepatitis or diabetes or cancer. Brains are always changing their learning, and addicts just have a supercharged form of learning.” It can therefore be unlearned.
“I’ve been a developmental psychologist for many years now,” Dr. Lewis says. “And I don’t think anyone comes out the way they are – they become the way they are. And you can think of that in terms of the gradual shaping of thought through experience, or you can think of it at the brain level, in terms of synaptic wiring, and the formation of stable synaptic networks in the brain. It’s the same thing, really. Mind you, there’s a lot of temperament that goes into it, so the initial set of constraints can be pretty powerful. By the time you’re in your 20s, you are who you are.”
Even so, Dr. Lewis kicked his own addictions. He finally learned to hear his cravings as just one more voice in his head, competing for attention.
The first step, he insists, was ending his first marriage, which was intertwined with his addiction: He used drugs, she abused him, he needed to use again, ad nauseam. His ex-wife is sharply depicted in the book as a bottomless pit of emotional need. (She once refused to let him attend a four-week drug treatment program because it would have left her on her own). Her emotional-blackmail techniques included lying down in front of his car as he tried to leave her.
Today, at 60, Dr. Lewis is married again, this time to a former graduate student in her early 40s, and is the father of twin five-year-old sons. He is a long way from the guy who liked to inject speedballs of heroin and cocaine into his veins for the sensation they produced that he was being tumbled in the waves of the ocean.
An opiate beckons
But the spectre of his former addiction is never far away. Emigrating a year ago to the Netherlands, where his wife is a tenured professor of developmental pediatrics, Dr. Lewis hurt his back, and was prescribed oxycodone. He finally stopped using it this June, months after his pain had subsided. “It took months to get off it. For me, it had all this imagery from long ago as well – I want to have that safe warm thing inside my body where no one can take it away for the next six hours. To me, that’s the core of what you’re after.”
Memoirs of an Addicted Brain
Dr. Lewis is convinced that feelings of inadequacy and shame – the devils that taunt most addicts – are actually universal, even if most of us won’t admit them. Those negative emotions co-opt our brain lanes more easily than we realize.
“When you’re a kid and you’re four or five years old, you feel shame when your parents shame you. It’s pretty straightforward. When they say something like ‘I told you nine times not to do that’ or ‘you’re being selfish,’ we feel shame, we hang our heads, we try not to do that thing.”
But shame is so painful and powerful, Dr. Lewis says, it may carve synaptic ruts as quickly as drugs can. “Where does it come from, the shame, after you’ve grown up? No one is actually saying things to you any more, but I think you internalize the parent.” If this is true, you will not be wanting to trowel on the emotional blackmail, Mommy, in case little Esmé becomes a junkie.
Advances in neuroscience have already suggested new approaches to treating addiction. Dr. Lewis cites dopamine inhibitors, and deep-brain stimulation (for depression) that breaks up habitual synaptic routes, as two promising possibilities.
But a cure for addiction may be impossible. If Marc Lewis is right, and addictive tendencies are as universal as he suggests, there is no such thing as an addict: There are only more and less extreme cases of neurological longing. Desire – the foundation of human choice, as rationalism would have it, and therefore of human dignity – is actually most of what we are, as human beings.
Because of the way cortical dopamine works, the prospect of feeling better (the thought of that dose, that hamburger) is even more motivating than the reward. Anticipation is all. As Dr. Lewis points out, if you block the dopamine receptors of a hungry rat sitting in front of a pile of food, it won’t eat. “It says, ‘Yeah, I’m hungry, but so what?’ So we need these systems to drive us to pursue any goal.”
He suspects this is why couples (and especially men) who spend all their time together get bored: They flood their dopamine systems, and then the engine of desire won’t even kick over.
These are not new findings, but, as the scientific foundation for the detailed memoirs of a former drug addict, they sharpen our understanding of why we do what we shouldn’t. It may even be an evolutionary flaw. “The brain’s condensation of value – its tendency to reduce human longing to the most easily satisfied patterns – is a mistake,” Dr. Lewis writes. “It’s a mistake to be so reward-dependent. It’s always bad to put all your eggs in one basket. It’s better to diversify.”
The addicts certainly need to know that. But so do we all.
Ian Brown is a Globe and Mail feature writer.