The Thirteenth Step: Addiction in the Age of Brain Science

by Markus Heilig

Overview

The past thirty years have witnessed a revolution in the science of addiction, yet we still rely on outdated methods of treatment. Expensive new programs for managing addiction are also flourishing, but since they are not based in science, they offer little benefit to people who cannot afford to lose money or faith in their recovery.

Clarifying the cutting-edge science of addiction for both practitioners and general readers, The Thirteenth Step pairs stories of real patients with explanations of key concepts relating to their illness. A police chief who disappears on the job illustrates the process through which a drug can trigger the brain circuits mediating relapse. One person's effort to find a burrito shack in a foreign city illuminates the reward prediction error signaled by the brain chemical dopamine. With these examples and more, this volume paints a vivid, readable portrait of drug seeking, escalation, and other aspects of addiction and suggests science-based treatments that promise to improve troubling relapse rates. Merging science and human experience, The Thirteenth Step offers compassionate, valuable answers to anyone who hopes for a better handle on a confounding disease.

Product Details

ISBN-13:	9780231172370
Publisher:	Columbia University Press
Publication date:	02/13/2018
Pages:	320
Product dimensions:	6.00(w) x 8.90(h) x 0.80(d)
Age Range:	18 Years

About the Author

Markus Heilig is a physician scientist and one of the most highly cited addiction researchers of his generation. For the past decade, he has led one of the largest research programs on addictive disorders in the world at the National Institute on Alcohol Abuse and Alcoholism at the National Institutes of Health. He is a fellow of the American College of Neuropsychopharmacology and is an editor of leading scientific journals in the field.

Table of Contents

Acknowledgments
1. Us and Them
2. A Grocery Store That Closed
3. An Entity in Its Own Right
4. A Chronic, Relapsing Disorder
5. Man or Machine?
6. Histories, Brains, and Behaviors
7. The Pursuit of Happiness
8. The Dark Side of Addiction
9. Rash Actions
10. Turning On a Bright Light
11. Getting the Cue
12. A Strained Mind
13. Fathers and Sons
14. Molecular Culprits
15. Trick or Treatment
16. Please Behave
17. Pills for Addiction Ills
18. Pray If You Wish, but Please Take Your Meds First
19. The Journey Ahead
Notes
Index

Editorial Reviews

Heilig makes the science of addiction accessible to both lay and professional audiences alike with an engaging conversational tone laced with humor and illustrative vignettes. He draws the reader in and effectively consolidates complex concepts. I applaud his efforts to bring the plight of the addicted to the attention of others and for his calling upon the field to do its very best to help.

Valerie J. Slaymaker

Heilig is one of the wisest, smartest, most insightful people I know. And what Heilig is, so is this book. A fantastic journey across one of the most complex and misunderstood problems of our time.

Pier Vincenzo Piazza

Poignantly written and personal, yet presents the current science of addiction in a clear and engaging way. Markus Heilig's exploration of addiction science is beautifully written and is a must-read for anyone who wants to understand why addictive behaviors and bad habits are difficult to give up, and how to do it. Heilig has masterfully laid out his own clinical experiences and concisely presented the science of addiction. His book brings to life the countless devastating effects of addiction that affect individuals across all strata of society while attacking the stigma of addiction and shows the importance of neuroscience in understanding and treating it.

Rajita Sinha

It was a great pleasure to read this book. Without being openly critical of the usual talk therapy, Heilig outlines the newest treatments that should be offered to every patient suffering from addiction. He shows that treatments today can be based on recent scientific knowledge about what is happening in the brains of alcoholics and describes new treatments based on current knowledge about the disease. Heilig, a world-class expert, has done a tremendous service for patients and their families by writing this book.

Charles P. O'Brien

What makes this book especially compelling is the author's ability to smoothly transition between dealing with addictions at the human clinical level and at the more abstract level of scientific research. Heilig admirably tries to extract the most meaningful takeaway points from sometimes-dense scientific findings.... Highly recommended.

Choice

[The Thirteenth Step] offers a brilliant and, perhaps more important, highly legible review of current addiction science.... Heilig's synthesis invites us all to critically consider the addiction concept along with its implications for people, policy, and the practice of medicine.

H-Sci-Med-Tech - Kyle Bridge

Markus Heilig has succeeded in making the airy dismissals of biological evidence-based approaches to addiction, such as those he heard in medical school, no longer tenable.

Times Literary Supplement - Séamus Sweeney

Markus Heilig has succeeded in making the airy dismissals of biological evidence-based approaches to addiction, such as those he heard in medical school, no longer tenable.

Times Literary Supplement - Séamus Sweeney

A very comprehensive perspective on drug addiction for a physician facing the clinical challenges of a diseased that is mostly ignored. It's a perspective I had not previously read in any book of addiction that I have encountered: especially in its sensitivity, honesty and the incredible clinical and scientific knowledge of the author.

Nora Volkow

04/01/2015
Physician scientist Heilig (clinical director, National Inst. on Alcohol Abuse and Alcoholism at the National Insts. of Health; fellow, American Coll. of Neuropsychopharmacology) argues that the science of addiction has relied on outdated treatment methods and that most patients with this disease receive the same type of archaic care. The material, which is written for laypeople and practitioners, is well organized with copious references citing scientific studies. Heilig discusses the latest treatments that practitioners should give to their patients so a relapse doesn't occur and explains the neurology of the condition in detail. Additionally, the author highlights the main points from stories of patients from various walks of life and the emotional effects addiction has on family and friends. He clarifies beliefs that people may have about addiction sufferers and humanizes individual experiences by sharing thoughtful and sensitive treatment advice and accounts. VERDICT This title is recommended for anyone who suffers from addiction or who knows someone who does; undergraduate and graduate students, scholars, and researchers studying medicine, particularly addiction and neurology, and psychology; and anyone who has an interest in learning more about the subject.—Tina Chan, SUNY Oswego

Library Journal

2015-03-05
Heilig sums up what he has learned during his 20 years as a physician and researcher in the treatment of alcohol and other addictive disorders. The author is a specialist in the field of neuropsychopharmacology, and he has treated patients and directed research for two decades in the United States and Sweden. Heilig subscribes to the view that "addiction is inherently a chronic, relapsing disease, not much different from…hypertension, diabetes, or asthma," which, while not curable, can be successfully managed so that sufferers can lead productive lives. Continued abuse of an addictive substance creates transformations in the brain that create a physiologically based need for the drug in order to avoid the pain of withdrawal as well as the necessity of taking a higher dose to experience pleasure. Environmental factors such as stress can trigger recurring drinking bouts, even in cases where patients have not ingested alcohol for a sustained period and no longer suffer from symptoms of withdrawal. The author also examines the genetic component of addiction. In the case of drinking, it is connected to the ability of alcoholics to get pleasurably drunk without experiencing immediate negative consequences such as nausea, dizziness, or blackout. While there is consensus within the medical community that alcoholism is a disease, its chronic nature is not yet sufficiently recognized and requires continued medical intervention. Heilig reports on his own research, which involves studying how the brain's neural circuitry is hijacked by addictive substances that trigger the release of high doses of the neurotransmitter dopamine, which creates the perception of pleasure. His aim is to develop counteractive drugs that have minimal side effects. Heilig writes compassionately of the problems of patients caught in the grip of addiction whose lives often spiral out of control despite their struggle to remain sober. There are "two perspectives" he writes,"of science and humanism," which "are inseparable in any area of medicine, but perhaps most so in psychiatry and addiction medicine." An informative and compassionate chronicle of Heilig's own growth as a physician and researcher.

Kirkus Reviews