The Biology of Desire: Why Addiction Is Not a Disease by Marc Lewis offers an alternative to the medical model of addiction. Rather than describing addiction as a disease, Lewis explores how desire, learning, and repeated patterns of behavior shape the brain. He supports his perspective with neuroscience, personal accounts, and lived experience, making a complicated subject approachable without requiring any particular background in psychology or addiction treatment.
I recommend this book to anyone working directly or indirectly with people experiencing addiction, anyone with friends or family members struggling with addiction, or anyone experiencing addiction themselves. Yes, I realize I’ve just described pretty much everyone. Whether you agree with Lewis’s conclusions or not, the book offers an opportunity to reconsider what addiction is and how we understand the people experiencing it. I particularly appreciate how Lewis blends neuroscience with human stories. He humanizes addiction, which I believe is an important part of reducing stigma and judgment.
I’ve worked as a substance use clinician since 2014, although I found my way into the profession somewhat indirectly. My education was in general psychology, with a master’s degree emphasizing industrial/organizational psychology. After more than a year of unsuccessful job searching, I expanded my options and accepted a clinician position at a medication-assisted treatment clinic for opioid dependence. I entered the field a novice and was introduced to the medical model of addiction as a disease. I read about it, listened to my colleagues, and adopted the philosophy. It made sense. Wanting to become more knowledgeable, I began reading books about addiction. Amazon eventually recommended The Biology of Desire, and I ordered it, curious to understand why Lewis believed addiction wasn’t a disease. The book changed my thinking. Understanding addiction as a desire-driven pattern of behavior made sense, too, and aligned more closely with my beliefs about human autonomy and decision-making. I’m not suggesting addiction is simply a choice, but I see it more as a consequence of patterns of choices than as a disease.
This book was influential enough that a phrase from its pages became the name of this website: Imagine Moving On. You can read more about that in my post Imagine Moving On. Whether the book changes your beliefs about addiction or simply expands your understanding, I think it’s well worth reading.
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