Alkohol, droger och hjärnan: Tro och vetande utifrån modern neurovetenskap

by Markus Heilig

Alkohol, droger och hjärnan beskriver framsteg inom hjärnforskningen som gjort det möjligt att bättre förstå alkohol- och drogproblem. Boken är skriven från författarens perspektiv som läkare och forskare och visar hur vetenskapens framsteg pekar ut vägar mot empatisk, rationell behandling som alternativ till moraliserande attityder och vårdideologiska strider.

Missbruksproblem är mycket vanliga, och nästan varje familj har erfarenhet av någon som drabbats. Svenskars användningsmönster av alkohol har förändrats. After Work-ölen och mitt-i-veckan-drinken är förhållandevis nya i svensk dryckeskultur, samtidigt som traditionen av tungt helgdrickande finns kvar. Dessa dryckesbeteenden aktualiserar behovet av fördjupad kunskap och vetenskapligt grundade behandlingsmetoder. För att nå dit behöver forskningens resultat nå ut utanför akademiska kretsar.

Genres: Psychology, Addiction, Science, Counselling, Health, Mental Health, Medicine

300 pages, Hardcover

First published May 12, 2015

Reviews

[Morgan Blackledge · Rating 5 out of 5]

I haven't posted a review in a (long) while because I was studying for my LMFT licensure exam, which I passed (BTW), and now I'm working on a PsyD (it's like a PhD for therapists, so it's like, ummmmm, how do you say ummmmm, easier?).

So any way, I'm really fuckin' busy and I don't really feel like writing when I'm not busy (which is like never). I'm not bragging or complaining. Life is good, but not awesomely so. This is just a roundabout way of saying that this book (The Thirteenth Step) is so good that I felt compelled to write this lame AF review.

If you're jonesing for a good book on the science of addiction written by a real addiction researcher, for the regular guy/gal, than look no farther, here it is.

For those of you 12-Steppers out there. This is an unfortunate title, and it's not about what you are thinking it's about. For those of you who are not familiar with 12-Step vernacular, the 13th step is to have sex with another person in 12-Step (usually a new-comer, ewww).

Anyway. It's about science. Sorry about that. I know how you 12-Step guys hate science (ohhhhhhh disss).

Sorry. That's all I have. I'm going to go eat carbs and take a nap now. Read this book.

[David Bird · Rating 3 out of 5]

The factual presentation of this work is straightforward and within the limits of the author’s frame of reference, useful. Most importantly, he offers a scientific basis for the disease model of addiction and explaining the physiology of the disease.

Yet his limits are constantly present. For Marcus Heilig comes across as almost the stereotype of an MD: he is absorbed in what he knows is a noble and humane pursuit, yet more concerned with humanity than humans. He is intrusively aware of his own intelligence, and condescends to his readers (“if that’s too abstract, let’s try again...”)—always a tiresome quality.

He finds the politics of his own profession fascinating—who won (or did not win!) a Nobel), and so on—much more fascinating than I do.

Chapters begin with vignettes drawn from clinical experience, but these seem to be important to him for what science they supported, what thoughts were provoked in him, what they taught him as cases rather than as individuals. The closest he comes to sharing the experience of an adict is in his own encounter with the euphoria of morphine.

I was mentally comparing this author with van der Kolk, author of The Body Keeps the Score, who conveys, in stories that similarly introduce chapters, that he is a student of individuals, learning from what works for them: he moves between anecdote and data in a way that honors the respective strengths of each. For Heilig, in contrast, individuals seem too much to be data points.

Heilig’s advocacy of evidence-based practice is welcome in a field that retains a strong influence of faith healing, but he fails to balance that with the patient-centered reality of addiction. The difficulty of this is that addiction remains at a place where medical intervention is, by the author’s own admission, highly limited. Insofar as successful treatment occurs, medicine is an adjunct to the patient’s own agency.

Engagement with that reality would have produced a stronger and more nuanced book. For example, he dismisses self-medication as an aetiology based on clinical data without engaging with why it is such a pervasive and powerful explanation among people with addictions. Data and anecdote are different things, but a good data-based theory that contradicts a mass of anecdote offers some explanation of the disparity.

The virtues of this book may allow it to help people with addictions better understand themselves, and medical professionals to support them more effectively. But, ultimately, I found myself glad to be done with it.

[Emily · Rating 3 out of 5]

It was interesting to read this book 3 years into doing alcohol addiction research and having been to 2 alcohol conferences. Heilig effectively summarizes current and historical theories of addiction. He points out flaws in current treatment plans and draws attention to the fact that alcohol addiction is a chronic, relapsing disease that typically can't be fixed with one detox. He acknowledges that AA and other 12 step programs have ignored or scorned medications like Naltrexone, which can help limit intake of alcohol if not stop alcohol intake altogether. All in all, this is an interesting book that you should read if you believe that people with addictions have some sort of moral failing or if you believe that the only way to reduce harm is complete sobriety without the help of any medication.

[Daniel Falkemo · Rating 4 out of 5]

När man sagt att alkoholism är en sjukdom har jag känt ett motstånd och inte kunnat köpa det. Jag ville därför läsa på för att bättre förstå bakgrunden till att kalla det sjukdom. Det har den här boken lyckats med. Jag är nu benägen att hålla med om sjukdomsbegreppet. Flera viktiga insikter har givits mig utöver det.

Det är en bok med starkt vetenskapligt fokus på bakgrunden och behandlingar av beroende sjukdomar. Det förmedlas med värme och humanism. För någon med mina dåliga förkunskaper om hjärnan och farmakologi blir det ibland svårt att hänga med i vissa stycken. Jag vill ändå rekommendera boken varmt för det sätt som den ändrat mitt sätt att se på beroende och på de som är drabbade av beroendesjukdomar.

[Amy S · Rating 3 out of 5]

An interesting book about the neuroscience, genetics, behaviors, psychology, and treatments of addiction. It was a little over my head and was a bit slow going for me but just the fact that I finished it shows that it held a wealth of information worth making the effort for. I may return to this book when I've had a chance to study a little more and put together a better foundation for understanding the scientific and medical aspects I was struggling to grasp.

[Serdar · Rating 4 out of 5]

Highly specialized but fascinating, and evidence-based where far too much discussion of this subject is not.

[Nancy · Rating 3 out of 5]

Science parts were often over my head. I like very much the call for addiction tx to be individualized and evidence based

[Wing · Rating 4 out of 5]

Addiction is a chronic illness of the brain with a propensity to relapse. Its basis is dependence-induced neuroadaptations and allostasis of the reward circuit. Impulsivity predisposes, stress precipitates, and a lack of social support perpetuates. The challenge is almost always about how to ameliorate priming-induced reinstatement and cue-induced craving, using evidence based treatment rather than quackery. The concept of compatibilist free will, in the context of genetics and neuroscience, is indirectly discussed, implied, and presumed. Very human and humane vignettes portray clearly how the social milieu interacts with the pathological brain, and give insights to the underlying mechanisms of treatment modalities. By cautioning against the fallacy of explanatory reductionism, more tailored treatments may arise through more informed researches.

[Michelle · Rating 5 out of 5]

Excellent read, with the latest neuroscientific evidence on addiction and its causes and contributing factors. Provides an excellent argument for treating addiction like any other chronic disease, with relapses and the need for recurring treatment. Neuroscience has become my passion, as it discounts the stigma that substance use disorders are a personal failure. There is hard science on how behavioral health and trauma impacts the brain and childhood development, down to the cellular level, impacting one's physical health well into middle-age and beyond.

Another great read: Childhood Disrupted - How Our Biography Defines Our Biology, and How You Can Heal.

[SoonGuan · Rating 3 out of 5]

offering a more humanistic perspective into the insights of addiction, dispelling the stigma that encompasses addiction