Book Review : A Compelling Theory About Addictions

Craving for Ecstasy: The Consciousness and Chemistry of Escape by Harvey B. Milkman and Stanley G. Sunderwirth (D. C. Heath: $14.95; 218 pp.)

How much of what we are is determined by chemistry and how much is subject to our control? The answer, as best we can tell, is that both factors are important. Each of us appears to be the result of a complicated interaction of nature and nurture.

But the more biologists learn, the more we seem to be biochemical machines--very complex, to be sure, but biochemical machines nonetheless.

In the end, will we be reducible to chemistry? Is there, in fact, a biochemical explanation for everything we feel, everything we think, every mood and emotion? If not, what else is there, where is this extra factor, and how does it function?

Harvey B. Milkman and Stanley G. Sunderwirth don't quite reach those questions in their fascinating book, "Craving for Ecstasy," but they come close. Nor is the ultimate nature of life a central theme of theirs. But it is an important subtopic, though they never address it directly.

"Craving for Ecstasy" is about addiction: drugs, food, alcohol, love, sex, gambling, danger--you name it. It is about the things that people get addicted to and what happens to them when they get addicted. It is about the chemical changes that happen in the brain when addiction occurs. Here you will read about the chemistry of falling in love. And you will also find out--from the point of view of chemistry--that playing hard to get is indeed the best approach.

One of the authors' insights is that all addictions are fundamentally the same. They all follow the same pattern, which Milkman and Sunderwirth describe in two stages. In the first stage, an individual finds that some object, some thing, provides great pleasure. The individual craves it--alcohol, say, or gambling or love--and uncontrollably begins seeking more and more of it.

But the pleasure that the addictive substance provides always begins to decrease. (The authors provide a chemical explanation for why a tolerance develops for drugs and why love fades.) The fly in the ointment is that no matter how much of a substance an addicted person gets, he always wants more.

Eventually, the addicted person enters the second stage of addiction, which the authors call maintenance. In this stage, the addictive substance provides little if any pleasure, but the addicted person continues to crave it in order to feel normal. Without it, he feels terrible and is depressed and may suffer withdrawal symptoms.

Milkman and Sunderwirth trace a compelling theory of addiction, in which addictive habits satisfy three deep needs: arousal, satiation and fantasy. They conclude that "it is love's unequaled capacity to profoundly influence each of the three pleasure planes . . . that qualifies it as the piece de resistance among the addictions."

Further, they say, "from a biological standpoint, the frequently held belief that sex is the most important part of a person's life is little more than a self-serving justification for poorly modulated excitatory biochemistry. While nature sets a biochemical predilection toward arousal, personal history directs the development of more or less successful styles of coping."

A Compelling Case

The chemistry and psychology of addiction are described with considerable insight. These authors know their stuff, and they make a compelling case.

"Whatever the seductive agent--substances, services or sweets--addicts repeat time and time again: 'Whenever it's right there in front of me, I have no choice. I've never been able to turn down a . . . ' " they write. "This subordination of rational thought and value-based decision making to the lure of momentary pleasure is at once the most mystifying and destructive aspect of the addictive process."

Unfortunately, at this point the authors become preachy, warning repeatedly of the dangers of addiction, which they call a "journey to oblivion." Here the book departs from a scientific discussion of addiction to a moral argument against it. The change in tone and focus is jarring.

The authors conclude with a discussion of various approaches to treatment, and they acknowledge that none of the treatments is particularly successful. The recidivism rate for addicts of all kinds ranges from 70% to 90%. Junkies go back to drugs, dieters regain the weight, criminals resume their lives of crime.

This lends further support to the notion of the biochemical basis of addiction and to the biochemical nature of life. Addictions have a very powerful hold on us because they become part of our chemical makeup.

But Milkman and Sunderwirth reject the distinction between chemical addiction and psychological addiction, in part, they say, because there is no difference between them. This is a controversial idea, but the authors make a convincing argument on its behalf. Psychological addictions become chemical addictions.

All in all, "Craving for Ecstasy" is a challenging, well-considered analysis of a behavior that afflicts large numbers of people.

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