Home Book Reviews The Science of Addiction: From Neurobiology to Treatment, 2nd Edition

The Science of Addiction: From Neurobiology to Treatment, 2nd Edition

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Written by Carlton K. Erickson

Reviewed by Olivia Clancy

The Science of Addiction provides up-to-date research to explain causes of and treatment options for addiction. In so doing, author Carlton Erickson informs readers of the many facets of addiction, i.e., neurobiology, genetics, brain disease, and offers a detailed look at its manifestations.

Thirteen distinct chapters help readers understand addiction. Chapters 1-3 focus on the terminology of addiction and why it confuses both professionals and the general public. A detailed look at what addiction is and what it is not is rooted in words. The author suggests that words like ‘addiction’ and ‘alcoholism’, as used in everyday conversations, are “colloquial, unscientific, stigmatizing, and just plain wrong” (pg. 3). “Words matter!” he writes. “Precise language reduces misunderstanding, stigma and false impressions” (pg. 4).

“Words carry great power—many words convey meaning, value, and carry emotional weight that affects how we view others. Some words even impact other people view themselves” (pg. 14).

While some of the book’s language is technical, the explanations provided as a result of such diction are invaluable to the book’s success. These seemingly complex and scientific concepts are explained using charts and diagrams, which makes them even more straightforward. Erickson also provides graphics that can be shown to people struggling with drug addiction and their families to visually explain the cause of their disease.

Because addiction is a combination of behavioral, biological, genetic, and physiological problems, Erickson shares the American Society of Addiction Medicine’s 2017 definition of addiction as a guideline to reduce confusion:

     “Addiction is a primary, chronic disease of brain reward, motivation,  memory and related circuitry. Dysfunctions in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance abuse and other behaviors.”

Addiction is characterized by the inability to consistently abstain impairment in behavioral control, craving, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response. Like other chronic diseases, addiction often involves cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death (pg. 6).

Moving deeper into the book, readers will learn about the neurobiological underpinnings of addiction, how the brain works, and how genetics play a role in order to understand “the pathology, symptoms and treatment principles that identify drug addictions as an authentic chronic medical disease” (p. 14).

According to Erickson, addiction is a chronic medical disease. The site of this disease is the mesolimbic dopamine system, aka our reward system. Neuroscientists believe that function of the brain region is disrupted due to “genetic mis-wiring, long-term exposure to a drug… or a combination of genetic heritability, drug exposure, and environmental influences.” (pg. 71) Additionally, mis-wiring of this brain region can result in an individual lacking crucial concepts such as reward and belonging which may further incline them to turn to alcohol or drugs to desensitize these feelings.

Dysfunction in this area leads to “characteristic biological, psychological, social and spiritual manifestations”, which is reflected in the individual’s persistent attempt to “pursue reward/relief through substance use” (pg 6).

While Erickson focuses on different drugs (stimulants and depressants), alcohol, and other drugs that create a high, he shares case studies to ground the information in real life situations. Treatment approaches—the challenges and possible outcomes—are covered in detail. This is displayed in the case study of “Lewis”, in chapter 11. After undergoing surgery and being prescribed Percodon, he stated he found the “missing link” to himself. When his prescriptions ran out, he began using heroin and became addicted to that. Lewis eventually began treatment at a methadone clinic where he struggled to receive a dose high enough to curtail his desire to use heroin again. Over several months, he continued treatment in long-term methadone treatment and was able to regain his life. This case study displays an abridged version of the difficulties faced by individuals with addiction, even once in treatment, as well as the intersection of different treatment methods.

The book ends with current research and an emphasis on future research creating an optimistic sentiment that left this reader anticipating what is yet to come in the field of addiction. A majority of these trends in research utilize neurobiology to further knowledge, such as finding specific genes that cause addiction vulnerability, brain-imaging studies to track recovery, algorithms to treat comorbid personality disorders and the neurological mechanisms that transition individuals from social drug use to severe SUD. (pg. 244-245)

Like the reader-friendly diagrams, other practical resources are also provided. Appendices A and B offer alcohol and drug concepts for “the aspiring neuropharmacologist”, respectively. Each section answers popular questions or states crucial information with a detailed explanation. Despite the fact the sections are intended for “the aspiring neuropharmacologist”, they are easily understandable.

A wide range of topics coupled with an abundance of information and thorough explanations leaves no potential question about addiction unanswered. The Science of Addiction is destined to become a pinnacle for addiction resources.

Carlton K. Erickson is a professor of Pharmacology/Toxicology, Associate Dean for Research and Graduate Studies and Director of the Addiction Science Research and Education Center in the College of Pharmacy at the University of Texas at Austin. He also received the Nelson J. Bradley Award for Lifetime Achievement, given by the National Association of Addiction Treatment Providers (NAATP).

Olivia Clancy studies applied psychology with a focus in children and adolescents at New York University where she is expected to graduate in May 2020. Having always had an interest in clinical psychology, her research interests include eating disorders, mindfulness practices and the intersection of the two.

Reference
Erickson, C. (2018). The science of addiction: From neurobiology to treatment, 2nd Edition. NY: W.W. Norton & Company.