This is your brain on drugs

Two years ago the city of Copenhagen offered to supply addicts with heroin. Local politicians hoped that the move would keep addicts from committing crimes and frequenting emergency rooms. Junkie heaven? Not quite. Only a small fraction of city's addicts signed up. The rest, program officials said, found the give-away program too regimented.

Judging from his self-portrait in "Memoirs of an Addicted Brain," Marc Lewis was once that kind of addict. He was hooked on subterfuge and defiance. He stole drugs, forged prescriptions and trawled black markets—for heroin and other mind-altering substances. He was arrested, he overdosed, he betrayed loved ones. And then he did it again and again until he decided not to.

Mr. Lewis's book is the newest addition to a popular genre, the addiction memoir. What distinguishes his entry is that he tells much of his story from the perspective of his brain, a "bristling, bustling, neural metropolis," as he calls it. Mr. Lewis, as it happens, is a developmental neuroscientist.

Mr. Lewis grew up in middle-class Toronto in the 1950s and 1960s. He was an insecure teen, he tells us, puzzled and hurt by his parents' insistence that he attend an American boarding school. Bullied by his classmates, he turned to alcohol, cough medicine and marijuana for relief. He graduated with honors, though, and went on to attend the University of California, Berkeley—where he tuned in, turned on and dropped out. After a year or so in Southeast Asia floating through opium dens in Calcutta, he was back in Berkeley to finish college and then pursue doctoral work in psychology. For about 10 years, he went in and out of full-blown addiction to narcotic painkillers and stimulants—and the Ph.D. he initiated was put on hold.

During this period, Mr. Lewis says, he learned that his brain "was accessible, mutable. I could change its chemistry, its balance. I could knock it out of one orbit and into another, if I tried, if I found the right substance." Scotch, for example, soothed him. Why, exactly? As he can now detail: Alcohol molecules affect "inhibitory neurons," which in turn cause other neurons to "remain buffered from each other, focused on the task at hand." LSD has a different effect. It "opens everything up so that even the tiny details of perception mushroom, layer by layer, an elaborate mandala. The world out there becomes a galaxy of sparkling connections because there are no serotonin filters modifying the stream of input."

At the core of addiction, Mr. Lewis suggests, is the biology of desire. "Whether in the service of food or heroin, love or gambling, dopamine forms a rut, a line of footprints in the neural flesh." He describes how a host of intoxicants from his own omnivorous experience—opium, heroin, alcohol, narcotic painkillers, methamphetamine, cocaine, Seconal, PCP, LSD, nitrous oxide—disrupt the neurochemistry of the brain. During opium addiction, for example, "the congealing and narrowing of synaptic traffic, criss-crossing among the orbitofrontal cortex, the amygdala and the ventral tegmental area, and the ventral striatum, leave less and less choice."

Granted, these descriptions are somewhat technical. But the author writes clearly and, along the way, provides a good primer in brain physiology. At times, though, he can be too definitive. Scientists, Mr. Lewis among them, are still exploring the neurobiology of addiction; a great deal remains unknown. Nor is pharmacology necessarily destiny, as he seems to imply. Situational factors—including the user's expectation of what a drug will feel like, the mood he is in and his social context—can exert a powerful influence on how a user experiences a drug.

What lessons can be gleaned from Mr. Lewis's life and brain? Foremost, his story illustrates the paradox of addiction: that even though the brain is changed by drugs, the brain-owner is not helpless. He can, if motivated, devise strategies to deafen himself to the siren call of altered states.

Mr. Lewis also reminds us that people keep using not just because of the physiological dynamics of addiction but because drugs serve a purpose. They quell anxiety, dissolve boredom, suppress self-loathing. As he puts it: "In one way or another, whether they are junkies or executives, people take drugs because they are not feeling right." The conventional wisdom among many experts, that addiction is a "chronic and relapsing brain disease," cannot readily accommodate such reality.

On occasion, Mr. Lewis is too ready to medicalize answers to life's painful questions. When he dumps a nice girlfriend, he asks: "What kind of person would turn away from this loyal and loving girl?" Answer: "My dopamine synapses were drying up and hardening, ceasing to respond to thoughts and images of Lisa." What explains his abdication of responsibility? "Addicts lose the mental muscle tone for self-direction, for resolve, for sobriety, for strength of character, and for decency itself." Yet, crucially, his story also shows that the drug-addled brain can repair itself through new patterns of thought and behavior—patterns that the author ultimately imposes upon himself.

"Memoirs of an Addicted Brain" delivers the classic redemptive arc. But the book telescopes so sharply at the end—the author's deliverance doesn't appear until seven pages from the end—that the transition from addict to university professor and family man seems to come out of nowhere. In his early 30s, Mr. Lewis tells us, a girlfriend left him, he dove into his stash and an inner voice stopped him, saying, "I deserve a chance to live." He goes on to describe, rather clinically, how he has remained clean and sober ever since. However abrupt the ending, the full tale is compelling, and for readers grappling with addiction, Mr. Lewis's mechanistic approach might well be novel enough to inspire them to seek the happiness he now enjoys.

Dr. Satel is a resident scholar at the American Enterprise Institute and a part-time psychiatrist in a methadone clinic.

 

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