Research in the philosophy of addiction commonly explores how agency is impacted in addiction by focusing on moments of apparent loss of control over addictive behavior and seeking to explain how such moments result from the effects of psychoactive substance use on cognition and volition. Recently, Glackin et al. (2021) have suggested that agency in addiction can be helpfully analyzed using the concept of affordances. They argue that addicted agents experience addiction-related affordances, such as action possibilities (...) relating to drugs, drug paraphernalia, and drug-related activities, as aberrantly salient motivations for action. Building on this approach, we present a novel two-tiered affordance model of addiction. In doing so, we suggest that what is significant about the addicted person’s world is not simply what affordances are experienced as salient, but also the way in which the addicted person’s world is shaped by a dominant concern. It is not only that addiction-related affordances become more prominent as addiction progresses but that one’s plurality of concerns become monopolized by and funneled through addiction. Our model endorses Glackin et al.’s idea that addiction-related affordances become aberrantly salient, while proposing why they become and remain so. This way of viewing agency in addiction also brings to light important implications for recovery and treatment. For, if an addicted person adopts a new, even “socially approved”, dominant concern, there is a risk that the shape of addiction is preserved, even though the content changes, leaving an individual at the risk of addiction substitution or relapse. (shrink)

Reprenant les principales dimensions psychopathologiques participant à la compréhension des conduites addictives alimentaires, et les articulant avec les mécanismes neurobiologiques générant et entretenant une véritable addiction, nous privilégions une approche psychosomatique qui permette d’éclairer certaines données cliniques, d’affiner nos attitudes thérapeutiques et d’ouvrir notre réflexion à des perspectives de recherche nouvelle. Dans une approche étiopathogénique, transnosographique, intégrant l’impact de l’environnement socioculturel et des dimensions transgénérationnelles, nous avons évoqué, dans le dysfonctionnement des interrelations précoces et ses conséquences sur le développement (...) de l’enfant et le processus d’adolescence, une hypothèse centrale dans les conduites addictives alimentaires : la défaillance du maternel chez les mères des patientes, en particulier dans l’investissement du corps autonome, vivant et érotique de l’enfant. Cette défaillance ne favoriserait pas une bonne intégration du féminin chez le sujet et participerait à l’avènement d’une organisation sadomasochiste qui le fixe à ses objets infantiles. Sur la base de ces modalités de construction identitaire, nous avons abordé la génèse de ces conduites en soulignant successivement le développement, du fait du défaut de contenant maternel (pare-excitant, organisateur et liant des motions pulsionnelles de l’enfant), d’une organisation dépressiveantidépressive (dépressivité), témoin d’une rupture du développement; celui d’une inactivation partielle, et dans certains domaines, des processus de mentalisation défensive du rapproché relationnel vécu comme emprise (alexithymie). L’organisation symptomatique évolue, selon nous, vers une modalité corporelle et comportementale de régulation de l’équilibre du sujet afin de parer à un risque dépressif ou de désorganisation. Ce processus de régulation touche le système plaisir-déplaisir avec la génèse d’un autosadisme et d’un masochisme moral, source d’une jouissance endogène « à défaut ». Ces dimensions ouvrent la voie à un frayage psychosomatique d’autant que les « solutions » névrotiques et perverses sont en échec, et qu’une pathologie organique secondaire à la conduite constitue un point d’appel de substitution d’une invalidité physique à une invalidité psychique. (shrink)

Through a fieldwork study of the practice of methadone substitution at a French addiction clinic, the classic ‘theory of action’ is criticized and an alternative one proposed. A sketch of the debates among French drug specialists, drug users and legislators shows the pertinence for these practitioners of such a theoretical question; further, the ethnographic data suggest that they can be seen as actually trying out an alternative to this ‘theory of action’.

This paper examines the evolution of ideas about narcotic addiction. In the eighteenth and early nineteenth centuries, addiction was not viewed as a medical condition, but as a ‘bad habit’. The contemporary reaction to De Quincey's Confessions demonstrates the general lack of medical involvement. The question of opium eating and longevity, first generated by the Mar case, brought increased medical interest and an embryo connection with the anti-opium crusade. In the second half of the century, addiction was (...) more fully ‘medicalised’ through the profession's involvement in the question of hypodermic morphine and the allied development of a disease theory of addiction. The ‘problem’ of hypodermic morphine owed much to medical perceptions; and the disease theory, too, was not scientifically autonomous. Medical thinking developed in close alliance with moral biases, temperance and anti-opium beliefs. Treatment structures and methods were elaborated in line with increased medical interest. In the early twentieth century there was a distinct move on the part of the government, and the Home Office in particular, to defeat the ‘disease’ view, and to substitute a penal policy. The 1926 Rolleston Report marked not simply a reassertion of the earlier moral-cum-medical emphasis, but a recognition of partnership between doctors and the state in which the limited nature of narcotic addiction at first ensured a liberal reaction. (shrink)

Patient and public involvement is widely thought to be important in the improvement of health care delivery and in health equity. Purpose: The article examines the role of experiential knowledge in service co-production in order to develop opiate substitution treatment services (OST) for high-risk opioid users. Method: Drawing on social representations theory and the concept of social identity, we explore how experts’ by experience and registered nurses’ understandings of OST contain discourses about the social representations, identity, and citizenship of (...) the participants and the effects these may have on developing or hindering inclusive and bottom-up forms of patient and public involvement. Results: The meeting sessions that potentially offer room for creativity and problem-solving fail to provide any new propositions for fixing the system. The health care professionals primarily identify themselves as regulators who protect the correctness of their actions and show little interest in considering experiential knowledge on opioid addiction. Conclusion: The participation of patients has been one of the prominent reforms implemented in health care. The goal of client-centered thinking is often emphasised; however, the implementation is not simple due to the strongly institutionalised knowledge and related working patterns and practices in health care. (shrink)

America’s industries and families continue to forsake cities for suburban and rural environs, in the process leaving nonproductive lands (brownfields) and simultaneously removing greenfield land from agriculturally or biologically productive use. In spite of noteworthy exceptions, urban regions which once functioned as vital communities continue in economic and social decline. Discussion or debate about the problem (or, indeed, whether it is a problem at all) invokes systems of values which often are not articulated. Some attribute the urban exodus to departure (...) from personal ethical norms (e.g., substance abuse, violence, welfare addiction) by urban residents, as though ethical decline is driving the phenomenon. Others take the exact opposite stance, that social and economic decline follow the departure of the economic base. There is no consensus on what government should do about the problem, or whether government should be involved at all. I present elements of a land-use ethic which can accommodate the foregoing. I argue that government is already involved in the brownfields problem because urban flight is facilitated by public policies which de facto subsidize the process. I further argue that the debate invokes key—but unexamined—assumptions regarding limits. Where there are few substitutes for resources and the social cost of exploitation is high, government intervention in the market is necessary; “value-free” economic approaches need to be supplemented by values concerning what ought to be, i.e., what is desirable for society. (shrink)

The debate for and against making e-cigarettes available to smokers is to a large extent empirical. We do not know the long-term health effects of vaping and we do not know how smokers will respond to e-cigarettes over time. In addition to these empirical uncertainties, however, there are difficult moral issues to consider. One such issue is that many smokers in some sense choose to smoke. Though smoking is addictive and though many start young, it does not seem impossible to (...) plan for and implement cessation. Yet many choose not to do so and we arguably have some reason to respect this choice. I propose that liberal opposition to strict tobacco control, based on respect for choice, is mitigated when e-cigarettes are available, since they are such a close substitute. Making e-cigarettes available to smokers might therefore not only enable switching in practice, but may make tougher tobacco control more justified. Another moral issue is that making e-cigarettes widely available might induce many people to vape, who would otherwise have neither vaped nor smoked. If this is so, the price of using e-cigarettes to accelerate smoking cessation may be a long-term vaping epidemic. Since vaping is less harmful than smoking, both individuals and society will have less reason to end this epidemic and so it may endure longer than the smoking epidemic would otherwise have done. This raises further questions around the weighing of reduced harm to current smokers against increased harm to future vapers. (shrink)

Evaluation of the potential of a cocaine vaccine requires a detailed understanding of the intended and unintended social consequences of its use. Prospective technology assessment is always difficult, but in the case of treatment and prevention of cocaine addiction we need to understand not only the neuroscience and pharmacology of cocaine addiction, but also social attitudes to drug use and addiction, the social context of drug use, and the factors which make drug use a rational strategy for (...) an addict and make treatment seeking or relapse more or less likely. By considering different scenarios related to differing levels of effectiveness of the vaccine, the authors argue that vaccination will be at best a useful adjunct to existing methods of treatment, rather than a substitute for them. (shrink)

America’s industries and families continue to forsake cities for suburban and rural environs, in the process leaving nonproductive lands (brownfields) and simultaneously removing greenfield land from agriculturally or biologically productive use. In spite of noteworthy exceptions, urban regions which once functioned as vital communities continue in economic and social decline. Discussion or debate about the problem (or, indeed, whether it is a problem at all) invokes systems of values which often are not articulated. Some attribute the urban exodus to departure (...) from personal ethical norms (e.g., substance abuse, violence, welfare addiction) by urban residents, as though ethical decline is driving the phenomenon. Others take the exact opposite stance, that social and economic decline follow the departure of the economic base. There is no consensus on what government should do about the problem, or whether government should be involved at all. I present elements of a land-use ethic which can accommodate the foregoing. I argue that government is already involved in the brownfields problem because urban flight is facilitated by public policies which de facto subsidize the process. I further argue that the debate invokes key—but unexamined—assumptions regarding limits. Where there are few substitutes for resources and the social cost of exploitation is high, government intervention in the market is necessary; “value-free” economic approaches need to be supplemented by values concerning what ought to be, i.e., what is desirable for society. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:A Response to Susan Laird, “Musical Hunger: A Philosophical Testimonial of Miseducation”Estelle R. JorgensenSusan Laird’s lament of her “musical under-education,” her youthful lack of opportunity for the sorts of experiences for which she hungered and its life-long after-effects, and her invocation of hunger as a metaphor for music education raise compelling questions. In a feminized field such as music, particularly piano playing, her hunger is particularly poignant. Also, the (...) notion of “musical taste” takes on new meaning, and the musical, educational, and ethical questions this metaphor evokes reveal its richness as a means of thinking about music education. This metaphor joins others such as Barbara Thayer Bacon’s metaphor of the quilt, Jane Roland Martin’s metaphor of the home, Iris Yob’s metaphor of pilgrimage, Elizabeth Gould’s metaphor of the nomad, Virginia Richardson’s metaphor of the steward, and Randall Allsup’s metaphor of the garage band, each of which illumines music education differently.1 Without one, we miss important insights into the thought and practice of music education; when taken together, they offer a richer view than were we to see music education in terms of one alone. [End Page 75]Although metaphor evokes imaginative thought and practice in music education, it is also limited. As Nelson Goodman aptly puts it, metaphor is a “matter of teaching an old word new tricks” and an “expedition abroad in which associations with one realm are applied in another.”2 Its power lies in its evocative and imaginative quality as it startles and surprises, challenges familiar ways of thinking and doing, and opens new possibilities for how we might think, act, and be differently. Although Laird would not want to literalize musical hunger or equate it with physical hunger—physical and spiritual realms intersect but they are not equivalent—it is possible to freeze a metaphor or literalize the vitality out of it. Testing it systematically, we enter the ground between metaphor and model, or what Iris Yob thinks of as the metaphorical model.3 While metaphor may prompt an intellectual journey, it cannot take us the entire way. In its particularistic and imaginative appeal, it opens reflection though it cannot suffice. A metaphor may also have a dark side. For example, envisaging the teacher’s role as salvific in providing bread for the hungry or preventing gluttony or food addictions may foster a paternalistic view that substitutes the teacher’s view of a student’s long term interests for the student’s directly-known and immediately perceived needs and interests, thereby subverting Laird’s expressed interest in the student’s desires. The educational “sin” of addiction may also be “redeemed” in Schefflerian fashion by pointing to important contributions of musicians who were doubtless excessive in their musical engagements.4 These possibilities suggest that we shall need to examine critically the metaphor and what it means for music education and move beyond the metaphor to its related models of music education.One of the interesting questions that Laird’s metaphor of hunger raises is the possibility of spiritual hunger, especially in a pervasively materialistic world. Matters related to spirituality have been addressed variously by writers in music education, whether it be the “healing” and ecologically-oriented approach of June Boyce-Tillman, the evolutionary and anthropologically grounded holistic approach of Anthony Palmer, the ethically-based approach of David Carr, the introspective and politically-charged writing of Cathy Benedict and Randall Allsup, the feminist perspectives of Elizabeth Gould, Charlene Morton, Roberta Lamb, and Deanne Bogdan, or the religiously grounded work of Iris Yob.5 Notions of spiritual hunger might be seen differently within the various lenses that these writers bring to music education but they all underscore the importance of knowing that goes beyond the literal, utilitarian, generalizable, and vocational to address the life of mind and body that Susanne Langer terms “feeling” and with which the arts, myths, rituals, and religions have to do.6 As such, they rebuke general education that is limited to reading, writing, and arithmetic, and driven by tests, standards, and mandates that often give short shrift to matters of human spirituality. Still, as the recent unanimous resolution in favor of... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Witness Against the Beast, William Blake and the Moral LawDan LatimerWitness Against the Beast, William Blake and the Moral Law, by E. P. Thompson; xxi & 324 pp. New York: The New Press, 1993, $30.00.The social context from which William Blake arose was fundamentally hostile to the grandiose projects of Court and official Church. So modest were the ambitions of Blake’s working-class forebears that their historical oblivion would (...) be assured, had they not professed theological views irksome to those whose job it was to enforce uniformity. The eccentric theology of this nonconformist class earned them the name antinomian, from “anti-nomos,” “against the law,” a term which carried the sense of both “heretic” and “terrorist.”Antinomians emerged from the Puritan Interregnum of the 1650s. They went quiet during the Restoration of Charles II, then were given a second life in the 1790s when the energies of Jacobinism refocused working-class frustrations on the hegemonic alliance of Court and Church. Eventually, sedition laws drove the antinomians underground to stay. Abhorring all official places of worship, they met over pints of beer in public houses, singing songs composed by themselves out of their home-made hymnals set to such unthreatening melodies as “God Save the King” to delude the casual passer-by.One such sect was the Muggletonians, whose very name ensured groans of genteel ridicule from the educated and powerful. They never numbered more than two hundred members in all of England. Taking their name from a seventeenth-century sectary, Ludowick Muggleton, they kept largely to themselves, did not evangelize, and did not pray, since they considered prayer servile. They met for fellowship, song, and hours of intricate theological discussion. For three hundred years, the faithful preserved the manuscripts of their prophets, records of discussion and debate, song books and membership lists, until Thompson tracked it all down in 1975 to a furniture depository in Tunbridge Wells. What Thompson wanted to show was some empirical connection between Muggletonian theology and the eccentric mythos of William Blake, since the two systems had so many already obvious antinomian similarities. It must have been discouraging for him to get no closer than “Hermitage,” the name of Blake’s mother’s first husband, a hosier named Thomas. In the Muggletonian song books are compositions from the 1750s by a George Hermitage, who in Thompson’s working hypothesis is a possible uncle of Blake. Thompson admits, however, that the image of Blake’s mother singing nonconformist family songs over the cradle of her infant son will have to remain a pretty fiction.Why does Thompson specifically want the Muggletonians in the Blakean picture? There are four pertinent articles of Muggletonian belief. The first is that they repudiate moral law, that is, the notion of religion as a system of discipline and punishment for sin. They substitute love and generosity as [End Page 412] characteristic of the divine principle. The second is that Reason is explicitly identified as a Satanic item, binding, constraining, and inhibiting the imaginative vision of God. The third article is the doctrine of the Two Seeds, according to which Satan, in the form of the serpent, had carnal relations with Eve, who subsequently gave birth to Cain, the serpent’s child and half-brother to Abel and Seth, the legitimate offspring of Adam. Henceforth, though, the Satanic and divine seeds are mixed in all human beings. The persistent Satanic element, the humanum maternum, gives our worshippers occasion, not only for an indictment of the rich and powerful, serpent-spawn all, but for a gnostic hostility for all material creation, including the body, implying, one need hardly say, a robust sense of woman’s addiction to the secret and forbidden, the worm that flies in the night.The fourth article deals with the divine influx of God into man on the occasion of Christ’s birth. For the Muggletonians, this incarnation (and eventual extinction) was entire. There weren’t any other parts of God left over somewhere else. Thompson sees here elements of a radical humanism which may have motivated such notions as “the human form divine” in Blake. On the other hand, the doctrine of the... (shrink)

Addiction and certain varieties of interpersonal attachment share strikingly similar psycho-behavioral structures. Neuroscientists, psychologists, and philosophers have often adduced such similarities between addiction and attachment to argue that many typical cases of romantic love represent addictions to one’s partner and thus might be appropriate candidates for medical treatment. In this paper, I argue for the relatively neglected thesis that some paradigmatic cases of addiction are aptly characterized as emotional attachments to their objects. This has implications for how (...) we should understand the nature of addiction and for the ethics of attachment more broadly. (shrink)

Addiction is standardly characterized as a neurobiological disease of compulsion. Against this characterization, I argue that many cases of addiction cannot be explained without recognizing the value of drugs to those who are addicted; and I explore in detail an insufficiently recognized source of value, namely, a sense of self and social identity as an addict. For people who lack a genuine alternative sense of self and social identity, recovery represents an existential threat. Given that an addict identification (...) carries expectations of continued consumption despite negative consequences, there is therefore a parsimonious explanation of why people who identify as addicts continue to use drugs despite these consequences: they self‐identify as addicts and that is what addicts are supposed to do. I conclude by considering how it is nonetheless possible to overcome addiction despite this identity, in part by imagining and enacting a new one. Importantly, this possibility requires the availability of social support and material resources that are all too frequently absent in the lives of those who struggle with addiction. (shrink)

In this paper, we contend that the psychology of addiction is similar to the psychology of ordinary, non-addictive temptation in important respects, and explore the ways in which these parallels can illuminate both addiction and ordinary action. The incentive salience account of addiction proposed by Robinson and Berridge (1993; 2001; 2008) entails that addictive desires are not in their nature different from many of the desires had by non-addicts; what is different is rather the way that addictive (...) desires are acquired, which in turn affects their strength. We examine these “incentive salience” desires, both in addicts and non-addicts, contrasting them with more cognitive desires. On this account, the self-control challenge faced by addicted agents is not different in kind from that faced by non-addicted agents – though the two may, of course, differ greatly in degree of difficulty. We explore a general model of self-control for both the addict and the non-addict, stressing that self-control may be employed at three different stages, and examining the ways in which it might be strengthened. This helps elucidate a general model of intentional action. (shrink)

Background: Recent literature on addiction and judgments about the characteristics of agents has focused on the implications of adopting a ‘brain disease’ versus ‘moral weakness’ model of addiction. Typically, such judgments have to do with what capacities an agent has (e.g., the ability to abstain from substance use). Much less work, however, has been conducted on the relationship between addiction and judgments about an agent’s identity, including whether or to what extent an individual is seen as the (...) same person after becoming addicted. Methods: We conducted a series of vignette-based experiments (total N = 3,620) to assess lay attitudes concerning addiction and identity persistence, systematically manipulating key characteristics of agents and their drug of addiction. Conclusions: In Study 1, we found that US participants judged an agent who became addicted to drugs as being closer to ‘a completely different person’ than ‘completely the same person’ as the agent who existed prior to the addiction. In Studies 2-6, we investigated the intuitive basis for this result, finding that lay judgments of altered identity as a consequence of drug use and addiction are driven primarily by perceived negative changes in the moral character of drug users, who are seen as having deviated from their good true selves. (shrink)

In this two-part analysis, I analyze Marc Lewis’s arguments against the brain-disease view of substance addiction and for a developmental-learning approach that demedicalizes addiction. I focus especially on the question of whether addiction is a medical disorder. In Part 1, I argued that, even if one accepts Lewis’s critique of the brain evidence presented for the brain-disease view, his arguments fail to establish that addiction is not a disorder. Relying on my harmful dysfunction analysis of disorder, (...) I defended the view that addiction is a medical disorder and a brain disorder. In Part 2, I consider some broader philosophical issues raised by Lewis’s arguments: I consider a larger puzzle, at the heart of the neo-Kraepelinian program in contemporary psychiatry, that is raised by Lewis’s argument that addiction is not a disorder because the brain displays no damage but only normal learning: must all mental disorders be brain disorders, or can mental disorders occur in normal brains? I argue that mental disorders can occur in normal brains. I critique Lewis’s response to the evolutionary “novel environment” approach to explaining why addiction is a disorder. Lewis agrees with brain-disease proponents that interpreting addiction as brain disorder relieves addicts of moral censure, but I argue that moral defect and brain disease are not exclusive. Finally, I consider Lewis’s “developmental-learning” account of addiction that encourages positive and empowering narrativizing of addiction, but I argue that the developmental-learning view is vacuous due to use of an overly broad notion of “development.”. (shrink)

In this article, I focus on possibly impaired self-determination in addiction. After some methodological reflections, I introduce a phenomenological description of the experience of being self-determined. I argue that being self-determined implies effectivity of agency regarding three different behavioural domains. Such self-referential agency shall be called ‘self-effectivity’ in this article. In a second step, I will use this phenomenological description to understand the impairments of self-determination in addiction. While addiction does not necessarily imply a basic lack of (...) control over one’s life, this can well be the case during certain periods of time or in special situations. Addiction is herein described as an embodied custom—highly effective with respect to changing one’s lived experience—which is learned and developed while becoming addicted. Such a repeatedly performed custom, called a ‘psychotropic technique’, implies deep changes in one’s personal identity and alters an agent’s ‘self-effectivity’. In the closing section, I discuss the possible implications of a phenomenological approach to personal responsibility. (shrink)

Addiction is almost universally held to be characterized by a loss of control over drug-seeking and consuming behavior. But the actions of addicts, even of those who seem to want to abstain from drugs, seem to be guided by reasons. In this paper, I argue that we can explain this fact, consistent with continuing to maintain that addiction involves a loss of control, by understanding addiction as involving an oscillation between conflicting judgments. I argue that the dysfunction (...) of the mesolimbic dopamine system that typifies addictions causes the generation of a mismatch between the top-down model of the world that reflects the judgment that the addict ought to refrain from drugs, and bottom-up input caused by cues predictive of drug availability. This constitutes a powerful pressure toward revising the judgment and thereby attenuating the prediction error. But the new model is not stable, and shifts under the pressure of bottom-up inputs in different contexts; hence the oscillation of all-things-considered judgment. Evidence from social psychology is adduced, to suggest that a similar process may be involved in ordinary cases of weakness of will. (shrink)

In this two-part analysis, I analyze Marc Lewis’s arguments against the brain-disease view of substance addiction and for a developmental-learning approach that demedicalizes addiction. I focus especially on the question of whether addiction is a medical disorder. Addiction is currently classified as a medical disorder in DSM-5 and ICD-10. It is further labeled a brain disease by NIDA, based on observed brain changes in addicts that are interpreted as brain damage. Lewis argues that the changes result (...) instead from normal neuroplasticity and learning in response to the intense rewards provided by addictive substances, thus that addiction is not a brain disease and by implication not a medical disorder at all. I argue that even if one accepts Lewis’s reinterpretation of the brain evidence, his conclusions do not follow. Relying on my harmful-dysfunction analysis of medical disorder, I defend the view that substance addiction is in fact a medical disorder and a brain disorder. In Part 1, I identify five arguments Lewis puts forward against the brain-disease view and evaluate them as arguments that addiction is not a disorder: Addiction is not a chronic, relapsing condition; There is no clear boundary between addiction and other strong desires; Negative consequences are not unique to disorders; The brain disease model does not account for behavioral addictions; and, Addiction is like love. I argue that Lewis’s arguments are invalid because they fail to take account of the context of addiction and its relation to biological design. (shrink)

I show that Pickard’s argument against the irresistibility of addiction fails because her proposed dilemma, according to which either drug-seeking does not count as action or addiction is resistible, is flawed; and that is the case whether or not one endorses Pickard’s controversial definition of action. Briefly, we can easily imagine cases in which drug-seeking meets Pickard’s conditions for agency without thereby implying that the addiction was not irresistible, as when the drug addict may take more than (...) one route to go meet her dealer. (shrink)

ABSTRACT‘Self-ambiguity’, we suggest, is best understood as an uncertainty about how strongly a given feature reflects who one truly is. When this understanding of self-ambiguity is applied to a view of the self as having both essential and shapable components, self-ambiguity can be seen to have two aspects: (1) uncertainty about one's essential or relatively unchangeable characteristics, e.g. one's sexuality, and (2) uncertainty about how to shape oneself, e.g. which values to commit to, actions to pursue, or essential features to (...) identify with. We explain how a narrative account of agency can accommodate these forms of self-ambiguity and argue that such an account also reveals another kind of self-ambiguity, namely, (3) uncertainty about whether one's established self-narrative represents who one really is. We illustrate this third form of self-ambiguity in the context of addiction where people's established addiction self-narratives make it difficult to identify with recovery. We argue that recovery will require embracing, especially, our third form of self-ambiguity as a chance for positive self-transformation. Treatment for addiction should, therefore, support people in going through and ultimately narratively resolving the inevitable self-ambiguities of the recovery process. (shrink)

Neil Levy argues that while addicts who believe they are not addicts are self-deceived, addicts who believe they are addicts are just as self-deceived. Such persons accept a false belief that their addictive behaviour involves a loss of control. This paper examines two implications of Levy's discussion: that accurate self-knowledge may be particularly difficult for addicts; and that an addict's self-deceived belief that they cannot control themselves may aid their attempts at self-control. I argue that the self-deceived beliefs of addicts (...) in denial and of self-described addicts differ in kind. Unlike the self-deception of an addict in denial, that of the self-described addict allows them to acknowledge their behaviour. As such, it may aid an addict to develop more self-control. A paradoxical implication is that this self-deception may allow an addict more self-knowledge. (shrink)

Normative thinking about addiction has traditionally been divided between, on the one hand, a medical model which sees addiction as a disease characterized by compulsive and relapsing drug use over which the addict has little or no control and, on the other, a moral model which sees addiction as a choice characterized by voluntary behaviour under the control of the addict. Proponents of the former appeal to evidence showing that regular consumption of drugs causes persistent changes in (...) the brain structures and functions known to be involved in the motivation of behavior. On this evidence, it is often concluded that becoming addicted involves a transition from voluntary, chosen drug use to non-voluntary compulsive drug use. Against this view, proponents of the moral model provide ample evidence that addictive drug use involves voluntary chosen behaviour. In this paper we argue that although they are right about something, both views are mistaken. We present a third model that neither rules out the view of addictive drug use as compulsive, nor that it involves voluntary chosen behavior. -/- . (shrink)

An important philosophical issue in the study of addiction is what difference the fact that a person is addicted makes to attributions of autonomy (and responsibility) to their drug-oriented behavior. In spite of accumulating evidence suggesting the role of emotional dysregulation in understanding addiction, it has received surprisingly little attention in the debate about this issue. I claim that, as a result, an important aspect of the autonomy impairment of many addicted individuals has been largely overlooked. A widely (...) shared assumption in the philosophical literature is that for addiction to impair a person’s autonomy it has to make them (in some sense) take drugs against their will. So-called “willing addicts” are therefore usually seen as exempted from the autonomy impairment believed to characterize “unwilling addicts”, the latter being those who ‘truly want’ to stop using drugs but find their attempts repeatedly derailed by failures of self-control. In this article, I argue that the association between addiction and emotional dysregulation shows why this assumption is false. Emotional dysregulation is not only consistent with the possibility that many addicts take drugs ‘willingly’, it supports the hypothesis that they use drugs because they truly want to. The article proposes an explanation for why emotional dysregulation should nevertheless be seen as an aspect of their loss of control and an important reason why they have impaired autonomy. I end by exploring some implications of this account for addict’s decision-making capacity when they are prescribed the drugs to which they are addicted. -/- . (shrink)

Does addiction to heroin undermine the voluntariness of heroin addicts' consent to take part in research which involves giving them free and legal heroin? This question has been raised in connection with research into the effectiveness of heroin prescription as a way of treating dependent heroin users. Participants in such research are required to give their informed consent to take part. Louis C. Charland has argued that we should not presume that heroin addicts are competent to do this since (...) heroin addiction by nature involves a loss of ability to resist the desire for heroin. In this article, I argue that Charland is right that we should not presume that heroin addicts are competent to consent, but not for the reason he thinks. In fact, as Charland's critics correctly point out, there is plenty of evidence showing that heroin addicts can resist their desire for heroin. These critics are wrong, however, to conclude from this that we should presume that heroin addicts are competent to give their voluntary consent. There are, I shall argue, other conditions associated with heroin addiction that might constrain heroin addicts' choice in ways likely to undermine the voluntariness of their consent. In order to see this, we need to move beyond the focus on the addicts' desires for heroin and instead consider the wider social and psychological circumstances of heroin addiction, as well as the effects these circumstances may have on the addicts' beliefs about the nature of their options. (shrink)

Mental conflict not always amounts to weakness of will. Irresistible motives not always speak of addiction. This book proposes an integrated account of what singles out these phenomena: addiction and weakness of will are both forms of secondary akrasia. By integrating these two phenomena into a classical conception of akrasia as poor resolution of an unnecessary conflict – valuing without intending while intending without valuing – the book makes an original contribution to central issues in moral psychology and (...) philosophy of action, including the relationship between responsibility and intentional agency, and the nature and scope of moral appraisal. In particular, the proposed integrated account is grounded in a general theory of responsibility and a related model of action as actualisation bringing together insights from both volitional and non-volitional conceptions, such as the intuition that it is unfair to hold a person responsible for things that are not up to her and the parity of actions and attitudes as legitimate objects of moral appraisal. Furthermore, the actualisation model supports a distinctive version of the Guise of the Good thesis which links valuing and intending in terms of success in action and explains why akratic actions and their offspring – addiction and weakness of will – are necessarily less than successful yet fully responsible. (shrink)

This paper tries to show that the naturalistic view of addiction is mired in contradictions that stem from reducing the addict to a weak-willed subject who loses control over his or her body. From a phenomenological perspective, addiction reveals itself to be a habit which eventually becomes harmful, but has its primary sources in the embodied needs of a worldly subject. The aim of this paper is to uncover the dimensions of the lived addiction that are neglected (...) in the contemporary naturalistic discourse: the lived-body and the worldly context of the addict. Firstly, we try to do justice to the variety of addictions by underlying that their new and surprising forms are determined by the intersubjective tissue wherein the subject operates. Secondly, the loss of control in addiction, how the subject deals with the tendency to satisfy a need, is experienced as powerlessness, as expressed in the accounts of ecstasy addicts regarding altered states of mind. The last section of this paper will argue that this sense of powerlessness cannot be equated with a weakness of the will because a strong, forceful will engenders the same vertigo of being prey to strange powers. The embodied aspect of addiction and the spontaneous, bodily need it saturates will clarify further this claim. (shrink)

Addiction appears to be a deeply moralized concept. To understand the entwinement of addiction and morality, we briefly discuss the disease model and its alternatives in order to address the following questions: Is the disease model the only path towards a ‘de-moralized’ discourse of addiction? While it is tempting to think that medical language surrounding addiction provides liberation from the moralized language, evidence suggests that this is not necessarily the case. On the other hand non-disease models (...) of addiction may seem to resuscitate problematic forms of the moralization of addiction, including, invoking blame, shame, and the wholesale rejection of addicts as people who have deep character flaws, while ignoring the complex biological and social context of addiction. This is also not necessarily the case. We argue that a deficit in reasons responsiveness as basis for attribution of moral responsibility can be realized by multiple different causes, disease being one, but it also seems likely that alternative accounts of addiction as developed by Flanagan, Lewis, and Levy, may also involve mechanisms, psychological, social, and neurobiological that can diminish reasons responsiveness. It thus seems to us that nondisease models of addiction do not necessarily involve moralization. Hence, a non-stigmatizing approach to recovery can be realized in ways that are consistent with both the disease model and alternative models of addiction. (shrink)

This book brings cutting edge neuroscience and psychology into dialogue with philosophical reflection to illuminate the loss of control experienced by addicts, and thereby cast light on ordinary agency and the way in which it sometimes goes wrong.

The claim that addiction is a brain disease is almost universally accepted among scientists who work on addiction. The claim’s attraction rests on two grounds: the fact that addiction seems to be characterized by dysfunction in specific neural pathways and the fact that the claim seems to the compassionate response to people who are suffering. I argue that neural dysfunction is not sufficient for disease: something is a brain disease only when neural dysfunction is sufficient for impairment. (...) I claim that the neural dysfunction that is characteristic of addiction is not sufficient for impairment, because people who suffer from that dysfunction are impaired, sufficiently to count as diseased, only given certain features of their context. Hence addiction is not a brain disease (though it is often a disease, and it may always involve brain dysfunction). I argue that accepting that addiction is not a brain disease does not entail a moralizing attitude toward people who suffer as a result of addiction; if anything, it allows for a more compassionate, and more effective, response to addiction. (shrink)

Impairment of self-control is often said to be a defining feature of addiction. Yet many addicts display what appears to be a considerable amount of control over their drug-oriented actions. Not only are their actions clearly intentional and frequently carried out in a conscious and deliberate manner, there is evidence that many addicts are responsive to a wide range of ordinary incentives and counter-incentives. Moreover, addicts have a wide variety of reasons for using drugs, reasons which often seem to (...) go a long way towards explaining their drug-oriented behavior. Many use drugs, for example, to cope with stressful or traumatic experiences. In this article I argue that some standard philosophical explanations of addicts’ impairment of self-control are inadequate, and propose an alternative. (shrink)

“The addict” is a well-known figure in philosophy, but analytical attempts to define “addictive disorder” are rare. According to extant views, the “hallmark” of addiction lies in an individual’s inability or impaired ability to control the behavior the individual is addicted to doing. But how exactly are we to understand the relevant concept of (in)ability (or impaired ability) in the first place? Furthermore, what else is necessary for an individual to have an addictive disorder? I argue for a definition (...) of “addictive disorder” in terms of desire, tolerance and withdrawal, inability, and harm. The main focus of this paper is on the concept of ability. The view I propose integrates insights from the literature on abilities and develops them further as they are relevant to addiction. The resulting view offers a more differentiated perspective on questions about what individuals with an addictive disorder can and cannot do. (shrink)

Supposing that addicts choose to act as they do, rather than being compelled to behave in particular ways, what explains the choices that they make? Hannah Pickard has recently pointed out that we can go a long way to answering this question if we can make sense of why addicts value the ends they pursue. She argues that addiction is a social identity that gives purpose and structure to life and that the choices that addicts make are valuable to (...) them as ways of sustaining this social identity. But if addicts freely make choices towards ends that they perceive as valuable in terms of a social identity to which they contribute, and therefore if addiction involves the deployment of quite considerable agential apparatus, how are we to hold on to the natural assumption that addictions are disempowering? In this paper I present an answer to this question. Drawing on the resources of the phenomenological tradition, I argue that some social identities give purpose and structure to life in a way that inhibits, rather than enables, the exercise of a capacity that is central to our form of life. I elaborate the hypothesis that paradigmatic cases of addiction involve this sort of disempowering social identity. (shrink)

Addicts are often portrayed as compelled by their addiction and thus as a paradigm of unfree action and mitigated blame. This chapter argues that our best scientific theories of addiction reveal that, psychologically, addicts are not categorically different from non-addicts. There is no pairing of contemporary accounts of addiction and of prominent theories of moral responsibility that can justify our intuitions about the mitigation of addicts but not non-addicts. Two conclusions are advanced. First, we should either treat (...) addicts as we normally treat non-addicts (as fully culpable) or embrace the skeptical conclusion that everyone is less responsible than we thought—perhaps not responsible at all. Second, we should be doubtful that theorizing about responsibility will be advanced by focusing on particular kinds of psychopathologies. (shrink)

How should addictive behavior be explained? In terms of neurobiological illness and compulsion, or as a choice made freely, even rationally, in the face of harmful social or psychological circumstances? Some of the disagreement between proponents of the prevailing medical models and choice models in the science of addiction centres on the notion of “loss of control” as a normative characterization of addiction. In this article I examine two of the standard interpretations of loss of control in (...) class='Hi'>addiction, one according to which addicts have lost free will, the other according to which their will is weak. I argue that both interpretations are mistaken and propose therefore an alternative based on a dual-process approach. This alternative neither rules out a capacity in addicts to rationally choose to engage in drug-oriented behavior, nor the possibility that addictive behavior can be compulsive and depend upon harmful changes in their brains caused by the regular use of drugs. (shrink)

Views on addiction are often polarised - either addiction is a matter of choice, or addicts simply can't help themselves. But perhaps addiction falls between the two? This book contains views from philosophy, neuroscience, psychiatry, psychology, and the law exploring this middle ground between free choice and no choice.

I argue that addiction is not an appropriate category to support generalizations for the purposes of scientific prediction. That is, addiction is not a natural kind. I discuss the Homeostatic Property Cluster (HPC) theory of kinds, according to which members of a kind share a cluster of properties generated by a common mechanism or set of mechanisms. Leading accounts of addiction in literature fail to offer a mechanism that explains addiction across substances. I discuss popular variants (...) of the disease conception and demonstrate that at least one class of substances that fails to confirm a major prediction of each account. When no mechanism can be found to explain the occurrence of the relevant properties in members of a category, the HPC view suggests that we revise our categories. I discuss options offered by the HPC view, including category revision and category replacement. I then conclude that talk of addiction as a prediction-supporting category should be replaced with categories such as “S-addiction” and “T-addiction,” where S and T are substances or sets of substances of abuse, as these categories are genuine natural kinds. (shrink)

It is often claimed that the autonomy of heroin addicts is compromised when they are choosing between taking their drug of addiction and abstaining. This is the basis of claims that they are incompetent to give consent to be prescribed heroin. We reject these claims on a number of empirical and theoretical grounds. First we argue that addicts are likely to be sober, and thus capable of rational thought, when approaching researchers to participate in research. We reject behavioural evidence (...) purported to establish that addicts lack autonomy. We present an argument that extrinsic forces must be irresistible in order to make a choice non-autonomous. We argue that heroin does not present such an irresistible force. We make a case that drug-oriented desires are strong regular appetitive desires, which do not compromise consent. Finally we argue that an addict’s apparent desire to engage in a harmful act cannot be construed as evidence of irrational or compulsive thought. On these arguments, a sober heroin addict must be considered competent, autonomous and capable of giving consent. More generally, any argument against legalisation of drugs or supporting infringement of the liberty of those desiring to take drugs of addiction must be based on considerations of harm and paternalism, and not on false claims that addicts lack freedom of the will. (shrink)

It is both common and natural to think of addiction as a kind of defect of the will. Addicts, we tend to suppose, are subject to impulses or cravings that are peculiarly unresponsive to their evaluative reflection about what there is reason for them to do. As a result of this unresponsiveness, we further suppose, addicts are typically impaired in their ability to act in accordance with their own deliberative conclusions. My question in this paper is whether we can (...) make adequate sense of this conception of addiction as a volitional defect. In particular, I want to focus on some philosophical assumptions, from the theory of action, that bear directly on the very idea that addiction might impair the agent’s volitional capacities. Understanding this idea, I shall argue, requires that we start out with an adequate conception of the human will. Only if we appreciate the kinds of volitional capacities characteristic of normal agents can we conceptualize properly the impairment of those capacities represented by addiction, and assess the implications of such impairment for questions of responsibility. (shrink)

Based on brain imaging findings, we present a model according to which addiction emerges as an imbalance in the information processing and integration among various brain circuits and functions. The dysfunctions reflect (a) decreased sensitivity of reward circuits, (b) enhanced sensitivity of memory circuits to conditioned expectations to drugs and drug cues, stress reactivity, and (c) negative mood, and a weakened control circuit. Although initial experimentation with a drug of abuse is largely a voluntary behavior, continued drug use can (...) eventually impair neuronal circuits in the brain that are involved in free will, turning drug use into an automatic compulsive behavior. The ability of addictive drugs to co‐opt neurotransmitter signals between neurons (including dopamine, glutamate, and GABA) modifies the function of different neuronal circuits, which begin to falter at different stages of an addiction trajectory. Upon exposure to the drug, drug cues or stress this results in unrestrained hyperactivation of the motivation/drive circuit that results in the compulsive drug intake that characterizes addiction. (shrink)

Recent experiments have shown that when individuals with a substance use disorder are confronted with drug-related cues, they exhibit an automatically activated tendency to approach these cues. The strength of the drug approach bias has been associated with clinically relevant measures, such as increased drug craving and relapse, and activations in brain reward areas. Retraining the approach bias by means of cognitive bias modification has been demonstrated to decrease relapse rates in patients with an alcohol use disorder and to reduce (...) alcohol cue-evoked limbic activity. Here, we review empirical and theoretical literature on the drug approach bias and explore two distinct models of how the drug approach bias may be embodied. First, we consider the “biological meaning” hypothesis, which grounds the automatic approach bias in the natural meaning of the body. Second, we consider the “sensorimotor hypothesis,” which appeals to the specific sensorimotor loops involved in the instantiation of addictive behaviors as the basis of the automatic approach bias. In order to differentiate between the adequacies of these competing explanations, we present specific, predictions that each model should make. (shrink)

Researchers working on drug addiction may, for a variety of reasons, want to carry out research which involves giving addicts their drug of choice. In carrying out this research consent needs to be obtained from those addicts recruited to participate in it. Concerns have been raised about whether or not such addicts are able to give this consent. Despite their differences, however, both sides in this debate appear to be agreed that the way to resolve this issue is to (...) determine whether or not addicts have irresistible cravings for drugs – if they do, then they cannot consent to this type of research; if they do not, then they can. This I will argue is a mistake. Determining whether or not addicts can say 'No' to offers of drugs will not help us to make much progress here. Instead we need to look at the various ways in which different types of research may undermine an addict's competence to give consent. What we will find is that the details of the research make a big difference here and that, as such, we need to steer a course between, on the one hand, painting all addicts as being unable to consent to research which involves providing them with drugs, and, on the other, maintaining that there are no problems in obtaining consent from addicts to take part in such research. (shrink)

Sensory substitution devices are a type of sensory prosthesis that (typically) convert visual stimuli transduced by a camera into tactile or auditory stimulation. They are designed to be used by people with impaired vision so that they can recover some of the functions normally subserved by vision. In this chapter we will consider what philosophers might learn about the nature of the senses from the neuroscience of sensory substitution. We will show how sensory substitution devices work by (...) exploiting the cross-modal plasticity of sensory cortex: the ability of sensory cortex to pick up some types of information about the external environment irrespective of the nature of the sensory inputs it is processing. We explore the implications of cross-modal plasticity for theories of the senses that attempt to make distinctions between the senses on the basis of neurobiology. (shrink)

Examining the author’s own experiences of narcotics addiction reveals certain aspects of the addicted mentality that have strong ethical valence. In general, this shows that addiction is not a state fundamentally characterized by lack. The rudiments of this position are found in some contemporary philosophy of addiction; also, it is contrasted with a common widely held mistaken view. Addiction should instead be understood in continuity with and as illuminating the nature of human personhood and subjectivity. Under (...) a phenomenology specific to the author’s experience, addiction appears as a mode of experience that has an unmanageable overflow of narratives created as discourses concerning people, events, thoughts, and feelings. (shrink)

We aim to find a middle path between disease models of addiction, and those that treat addictive choices as choices like any other. We develop an account of the disease element by focussing on the idea that dopamine works primarily to lay down dispositional intrinsic desires. Addictive substances artifically boost the dopamine signal, and thereby lay down intrinsic desires for the substances that persist through withdrawal, and in the face of beliefs that they are worthless. The result is cravings (...) that are largely outside the control of the addict. But this does not mean that addicts are bound to act on such cravings, since they typically retain their faculty of self-control. The issue is one of difficulty not impossibility. Controlling an addictive craving is exceedingly demanding. (shrink)

If one believes that the brain is, in some as yet unspecified way, the organ of mind and behaviour, then all human behaviour has a neurobiological basis. Neuroscience research over the past several decades has provided more specific reasons for believing that many addictive phenomena have a neurobiological basis. The major psychoactive drugs of dependence have been shown to act on neurotransmitter systems in the brain (Nutt 1997; Koob 2000); common neurochemical mechanisms underlie many of the rewarding effects of these (...) drugs and the phenomena of tolerance and withdrawal symptoms (Hyman & Malenka 2001; Koob 2000), and there is evidence for a genetic vulnerability to addiction (Nestler 2001; Uhl 1999) that is mediated by genes that regulate the metabolism of psychoactive drugs and the brain neurotransmitter systems on which they act (Uhl 1999). (shrink)

In the UK, current policies and services for people with mental disorders, including those with intellectual disabilities (ID), presume that these men and women can, do, and should, make decisions for themselves. The new Mental Capacity Act (England and Wales) 2005 (MCA) sets this presumption into statute, and codifies how decisions relating to health and welfare should be made for those adults judged unable to make one or more such decisions autonomously. The MCA uses a procedural checklist to guide this (...) process of substitute decision-making. The personal experiences of providing direct support to seven men and women with ID living in residential care, however, showed that substitute decision-making took two forms, depending on the type of decision to be made. The first process, ‘strategic substitute decision-making’, paralleled the MCA’s legal and ethical framework, whilst the second process, ‘relational substitute decision-making’, was markedly different from these statutory procedures. In this setting, ‘relational substitute decision-making’ underpinned everyday personal and social interventions connected with residents’ daily living, and was situated within a framework of interpersonal and interdependent care relationships. The implications of these findings for residential services and the implementation of the MCA are discussed. (shrink)