Science of Addiction: Lost in A Labyrinth
What is addiction? Despite my many years studying the mesolimbic system, one of the key players in many drug-dependent behaviors, I still struggle to define addiction. Erickson's efforts are admirable because it's not easy to answer.
The main purpose of this book is to raise a series of important, yet often overlooked, questions about addiction and make them interesting and stimulating to a wide audience. Erickson must discuss some difficult topics, but he is able to keep the ship going in treacherous waters.
Erickson provides information on many subjects related to neuroscience and addiction. There are chapters that focus on brain science basics, anatomy, genetics and treatment, as well as future directions in addiction research. Erickson does a remarkable job of answering all the questions that he poses.
Erickson starts right away in Chapter 1, and he focuses directly on some core questions. Can people agree about what addiction is? What's the difference between substance abuse and dependence? This term, as with addiction, is often misused without agreement between scientists, public health professionals, and the general public. Erickson argues that drug abuse, which he describes as bad judgment in drug use but not as a disorder, is distinct from pathological chemical dependency (impaired control of drug use), which Erickson defines as being a form of brain disease. Bad judgment, which is a more difficult concept to describe and has been seen in people with unrelated conditions like frontotemporal dementia, could be another argument. You could even argue that drug addiction is itself a "brain disorder", at least in some cases. Furthermore, pathological chemical dependence can be produced by repeated exposure to the drug to which a subject eventually becomes addicted. Erickson does eventually mention this possibility but some of his statements are a little too simple and clear for my liking.
Erickson adds an intriguing concept to this: even though pathological chemical dependence can lead to brain diseases, drug abuse is still a conscious act. Erickson calls this abuse, but I'm not sure if that is true. Although it is intentional, the brain pathways of those who have been exposed to drugs in the past may be altered. However, Erickson suggests that these individuals should be able to reduce or stop their drinking when they decide that the adverse consequences are worse than the desirable effects. Some people might stop using drugs intentionally, while others may fall into chemical dependency.
Although the rest of the book is well-written, I found it difficult to follow Erickson's different interpretations as he refers to the same concept differently throughout the book. More consistency would be helpful. The mesolimbic is not only a pleasure system, but its function strongly links to motivation. This is the case for example. Erickson eventually explains that mesolimbic systems are not just about pleasure. However, a one-and-for all description and definition would have been helpful.
Erickson stated that chemical dependency is a brain disorder associated with dysregulation in the mesolimbic systems. Another contradiction. While this may be true for certain people, it could also be the case with a small number of others. Many brain areas or pathways, such as the mesocortical, have been proven to be equally critical. Erickson fails to mention at first that the drug-dependent behavior is primarily mediated by the ventral Tegmental Area within the mesolimbic. But, Chapter 3 does finally include the ventral-tegmental areas.
Inconsistencies continue when Erickson states that there is no scientific evidence that babies born of drug-using mothers have a greater likelihood of becoming addicted. This is a very complicated problem, but some scientists would disagree with such a strong statement, as recent reports have shown the opposite: there is growing evidence from long-term clinical studies that adolescents and young adults born to drug-using mothers do have a greater chance of becoming drug abusers themselves, and the best evidence thus far comes from studies on tobacco smoking and alcohol.
This book is concise and covers a lot of information. I think this may be why certain concepts are simplified. Every chapter is worthy of a separate book.
The age-old conundrum is to decide whether it is best to provide answers or to leave the audience with open questions. Erickson was the one who caught my eye. He must also be praised for his effort-for the most part successful-to simplify and explain to a lay audience a very complicated, multifaceted health problem that, despite so many years of research, represents one of the most difficult challenges to modern science.