WHICH IS WHY ONLY 12 STEP PROGRAMS ARE EFFECTIVE...:

Dr Marc Lewis, a developmental neuroscientist - perhaps most famous for detailing his own years of drug addiction and abuse in Memoirs of an Addicted Brain - strongly refutes this conventional disease model of addiction. His new book, The Biology of Desire: Why Addiction is not a Disease, argues that considering addiction as a disease is not only wrong, but also harmful. Rather, he argues, addiction is a behavioural problem that requires willpower and motivation to change.

Lewis's theory has divided the medical profession and those suffering from addiction. He has been lauded by some for putting the theories challenging the disease model together into one book; others have labelled his ideas dangerous, and him a zealot.

Guardian Australia sat down with Lewis before his appearance at Melbourne writers festival on Sunday and the festival of dangerous ideas in Sydney to talk about the controversy, as well as his theories on how addiction can be treated and overcome. [...]

Why does it matter? Disease, disorder, behavioural problem? Does it affect the way we might think about treating those suffering from an addiction?

It sure does. The whole campaign to see addiction as a disease is that it works against people's sense of empowerment. If you have a disease, you're a patient. If you're a patient, you have to take instructions from your doctor and do what you're told. So people line up for rehabilitation centres and often have to wait for a long period of time, long after they've lost the motivational rush to actually quit.

Then if you do get into rehab, you're putting yourself in somebody else's hands and you're going with the program. But the best way to combat addiction is through setting different goals for yourself and setting your own goals. "I want this for my life, I don't want that, I want to change." That kind of self-perspective change and self-development of future goals and orientation is critical.

That's been an argument against rehabilitation, that it doesn't always set people up to meet personal goals and readjust to society.

That's right. It really hinges on the idea of who is setting the goals here. Who is telling you what to do? Are you telling yourself what to do, or are you being told? If you're being told what to do, you fall into a position of helplessness or disempowerment, which makes it hard to develop this head of steam, this effortful strength and self-control and willpower. I mean really, a lot of it is about willpower to master this thing, to take it in hand and change it. The best way to combat addiction is by setting goals for yourself.

Different types of rehab programs are needed for different types of drugs, for example it might take someone longer to get off ice than say, heroin, and therefore programs should be tailored to recognise that. But given what you're saying, would the model of treatment be relatively the same across all drugs, because it's more about willpower and setting goals than the type of drug being abused?

A good question. I don't think so. Even though it has those goals in common, people are very different and there are many ways to quit. Some people will need to focus more on cognitive tricks to self-program to modify their behaviour, others will need to change their environment to make sure they don't drive home past the liqour store, and for other people it's much more of a motivational thrust, more mindfulness and meditation. For others, it's about deeply connecting intimately and honestly with loved ones. Those are really different ways of getting better, even though what they all have in common is that theme of empowerment of self-motivation.

I can see why people with an addiction resist this way of thinking. No one likes to think of themselves of having a lack of willpower, or being to blame. Some members of the medical establishment are resistant to this idea too. Why do you think that is?

I think it's partly ownership, it's partly they way they've been trained to operate. I don't hate doctors, there are wonderful doctors. But doctors are trained to look at things in terms of categories, diagnoses, which have a certain set of possibilities for treatment or certain sequence of things to try. It's a really strongly inbred way of looking at very serious problems. And it's hard for them to shake it.

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