Merino, Jose G. MD
As a teenager in boarding school, Marc Lewis was lonely, homesick, and at the bottom the school's pecking order. He was bullied and had few friends, none of them close. But he discovered that alcohol, cough syrup, and marijuana allowed him to escape, even if for a short time, the dreary reality of his life. These substances changed how he felt and took him “from a hopeless reality to a compelling new landscape.”
When he arrived at Berkley in 1968, he dove into the drug scene. He experimented with purple haze, acid, LSD, and PCP. The more he used drugs, the more he craved them. And he sought them not only because they took him on wild and surreal carnival rides but also because they allowed him to “escape the claustrophobic monotony of being me.”
These drugs gave him thrills but did not take away his loneliness and feelings of worthlessness. Heroin, on the other hand, gave him a sense of bodily comfort, emotional wellbeing and clarity of thought. After he was expelled from college he travelled to Malaysia, where he discovered methamphetamines and nitric oxide, and to Calcutta, where opium became “a buttress of security against the dark clouds — boredom, loneliness, shame, circling self-doubt”; these clouds, however, reappeared every morning. Eventually he returned to Toronto and graduate school, but his drug use did not abate. To satisfy his cravings he stole drugs from homes, medical offices and the hospital where he was a psychology intern. He was discovered, placed on probation, and his marriage broke up. He considered suicide. But in his darkest moment he found strength to turn away from drugs.
Over the past thirty years a positive sense of self allowed Lewis to achieve personal, familial, academic and professional stability, and he is now a professor of developmental psychology at the Radboud University in Nijmegen in the Netherlands where his work focuses on the development of emotions and personality in children.
In this courageous memoir, Dr. Lewis recounts “the experience of addiction and the brain processes underlying it.” In each chapter he narrates an episode of his life and how it led to the use of a new drug. He vividly describes how each drug made him feel and clearly explains how these feelings arise from the interaction of the drug with specific neurotransmitters and pathways in the brain. As the book progresses the well-written explanations get more detailed, but remain accessible to a general reader. Using precise analogies and metaphors he describes the neurobiology of craving, desire, anticipation, and pleasure, and how drugs amplify these processes — leading to elation, happiness, anticipation, dissociation, contentment, and hallucinations.
For Lewis, drug addiction is largely biologically determined. Drugs compensate for unmet emotional and psychic needs that disrupt neurotransmitter systems. “So when times are tough emotionally, the stuff that's supposed to fulfill children's needs (e.g. getting held by a parent) gets traded in for the chemicals (e.g. opiates) designed — both by nature and by the manufacturers — to carry out that fulfillment where it actually takes place, in the flesh sitting snuggly behind our foreheads. Not only that, but the kinds of drugs we seek stand in for the kinds of needs that have gone unfulfilled.”
Just like practicing the cello or learning a new language, drugs remodel synapses in systems critical for thought and emotion. But for Lewis, addiction is a corrupted form of learning. The plastic changes are reinforced by the strong emotions associated with drug use. The addict's brain, therefore, “will never return to its state — of innocence? — that preceded it.” As a result, it is very difficult to escape drug addiction.
Lewis believes that understanding the biology of addiction is the only way to identify successful strategies to help addicts stop using drugs. The book, however, deals only superficially with the process of recovery, and leaves unanswered an important question: What are the biological and psychological processes that help a former addict break the cycle and avoid drugs, despite the brain's hunger for them?
Perhaps not surprisingly, given the memoir's emphasis on each individual's neurobiology and psychological needs, Lewis has very few comments about the societal impact of drug use and the effect of punitive policies on drug users. Lewis grew up in the 1960s and 1970s in North America. He was arrested a few times, spent several days in jail, and was placed on probation. Drug used led him to a life of petty crime and to a number of broken relationships, and he hurt many people close to him. But eventually he turned his life around. After reading the book I wondered how a similar young adult, perhaps from a less affluent background, would have fared in the decades of AIDS, the war on drugs, and mandatory sentencing.
By combining phenomenological and neuroscientific explanations of the effect of different drugs, Lewis takes us figuratively and literally inside the addict's brain — inside his own brain. After reading it, I had a greater understanding of the motivations for, and rewards and dangers of drug use, and of the way the drugs interact with the brain. This memoir gave me a new and valuable perspective on my patients, friends and colleagues who use drugs. I highly recommend this book.
Dr. Merino is a neurologist with Johns Hopkins Community Physicians and director of the Suburban Hospital Stroke Center in Bethesda, MD.
The neuroscientist featured here is not the only researcher to explore experimentation with drugs. In the Aug. 27 issue of The New Yorker, neurologist Oliver Sacks describes his own use, during the 1960s with a variety of drugs, including LSD, cannabis, and opium — and what it taught him about neurology, research, and patient care: http://nyr.kr/R4Qd7Y